Erasing narrow paravisceral true lumen with endoseptostomy to favor adequate expansion of branched endograft during postdissection thoracoabdomimal aortic aneurysm endovascular repair

Narrow paravisceral aortic true lumen in post-dissection thoraco-abdominal aneurysm, represents a challenging situation when branched endovascular aneurysm repair (BEVAR) is required; it may be responsible for intraprocedural technical difficulties as inadequate main endograft deployment, difficult vessels catheterization, or long-term branch instability related to compression. We describe the case of a 56 year-old male with post-type B thoracoabdominal aortic aneurysm (TAAA) and a severely narrow true lumen (10 mm) at the paravisceral segment. Endovascular aortic septostomy was performed first, in order to erase the narrow paravisceral aortic true lumen, and subsequently allow branched endograft adequate expansion and regular vessels catheterization.