Thermal septotomy–assisted thoracic endovascular aortic repair for management of mesenteric malperfusion in acute type A aortic dissection

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Acute type A aortic dissection with mesenteric malperfusion (n=1). Intervention: Thermal septotomy-assisted thoracic endovascular aortic repair (TEVAR). Primary outcome: Visceral reperfusion and stabilization for definitive central repair.

Stephanie Rodriguez; Charles Renner; Ryan William King

doi:10.1016/j.jvscit.2026.102268

April 18, 2026Journal of Vascular Surgery Cases and Innovative TechniquesOpen Access

Thermal septotomy–assisted thoracic endovascular aortic repair for management of mesenteric malperfusion in acute type A aortic dissection

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Key result

Thermal septotomy-assisted TEVAR successfully restores visceral perfusion before definitive open repair in type A dissection.

n=1

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Why the study?

Mesenteric malperfusion in acute type A aortic dissection carries extremely high mortality.

Study Design

Type

Case Report (n=1)

Structured PICO

P

Population

A 53-year-old woman with acute type A aortic dissection and mesenteric malperfusion, treated with an endovascular-first approach and followed for 1 year.

I

Intervention

Endovascular-first approach using thermal septotomy (via steel-core wire and electrocautery) from zone 4 to zone 5, followed by deployment of a thoracic endovascular aortic repair (TEVAR) stent graft (CTAG 34 × 150 mm) in the descending thoracic aorta to restore visceral perfusion, followed by immediate open hemiarch repair and aortic valve suspension.

Thermal septotomy-assisted TEVAR may serve as a feasible and effective endovascular-first bridge to open central repair in patients with acute type A aortic dissection and life-threatening visceral malperfusion.

Limitations

Findings are based on a single case report.
Septotomizing the visceral segment is unpredictable and can potentially lead to visceral vessel occlusion.
Performing hemiarch repair in the same setting as TEVAR may contribute to hemodynamic instability and subsequent spinal cord ischemia.
Use of thoracic aortic stent grafting in combination with central repair increases upfront costs and operative risks.
Single case report
Performing hemiarch repair in the same setting as septotomy/TEVAR may have mitigated blood loss but contributed to labile blood pressure, vasoplegia, and subsequent spinal ischemia compared to a delayed approach

Implication

May support endovascular bridge in select high-risk malperfusion cases; hypothesis-generating and requires prospective validation before wider use.

Abstract

Mesenteric malperfusion in acute type A aortic dissection (ATAAD) carries extremely high mortality. A 53-year-old woman presented with ATAAD and mesenteric malperfusion and was deemed to be at prohibitive risk for central repair. An endovascular-first approach was used to treat visceral malperfusion before central repair. Thermal septotomy was performed to create a proximal landing zone in the descending thoracic aorta, allowing full expansion of thoracic endovascular aortic repair and mitigating the risk of retrograde false lumen pressurization. The distal landing zone in the true lumen provided rapid expansion and visceral reperfusion. Thermal septotomy-assisted thoracic endovascular aortic repair can bridge to central repair in select high-risk patients with ATAAD and mesenteric malperfusion.

Discussion

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Cite This Study

Rodriguez et al. (2026) conducted a case report in Acute type A aortic dissection with mesenteric malperfusion (n=1). Thermal septotomy-assisted thoracic endovascular aortic repair (TEVAR) was evaluated on Visceral reperfusion and stabilization for definitive central repair. Thermal septotomy-assisted TEVAR safely restored visceral perfusion and served as an effective bridge to definitive open central repair in a patient with acute type A aortic dissection.

synapsesocial.com/papers/6a982a3ecc61a2345e6c754c https://doi.org/10.1016/j.jvscit.2026.102268

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Thermal septotomy–assisted thoracic endovascular aortic repair for management of mesenteric malperfusion in acute type A aortic dissection

Figures

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Thermal septotomy–assisted thoracic endovascular aortic repair for management of mesenteric malperfusion in acute type A aortic dissection

Figures

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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