Transcatheter Electrosurgical Aortic Septotomy across the Spectrum of Type B Aortic Dissection: Feasibility, Technical Lessons, and Bailout Strategies

Objective Transcatheter electrosurgical aortic septotomy (TEAS) has been introduced to optimise luminal geometry during complex endovascular repair of type B aortic dissection (TBAD), but data across dissection phases and on complication management remain limited. This study reports early outcomes, quantitative common lumen creation, and bailout strategies from a consecutive single centre experience. Methods Eight consecutive patients underwent TEAS, between December 2024 and January 2026, as an adjunct to thoracic endovascular aortic repair or physician modified fenestrated endograft for acute, subacute, or chronic TBAD, including post-type A repair and genetic aortopathy. Preprocedural and follow up computed tomography angiography (CTA) quantified true lumen and common lumen cross sectional area. Septotomy technical success, peri-operative outcomes, complications, and early follow up were assessed. Results Mean age was 51.1 ± 17.0 years; five were men. Two patients were acute, two subacute, and four chronic; two had Marfan syndrome, both redo cases after prior open repair. Septotomy technical success was 100%. Median cross sectional area increased from 174.5 mm 2 (preprocedural true lumen) to 1 007 mm 2 (follow up CTA common lumen) after TEAS (5.3 fold increase). There was no 30 day, in hospital, or aortic related mortality. Three major procedure related complications (38%) occurred, all in non-acute cases and all managed endovascularly: one iliac lamellar dislodgement requiring kissing stents, one external iliac rupture treated with stent grafting, and one delayed superior mesenteric artery occlusion managed with stenting. All acute cases were uneventful. Median clinical follow up was 32 days (range 22 – 308) and median imaging follow up was 20 days (range 2 – 265), with no late mortality and no aortic re-intervention, and no aneurysmal dilatation of the non-stented TEAS treated segment. Conclusion TEAS may be considered across acute, subacute, and chronic TBAD, including redo and connective tissue disease cases, enabling reproducible common lumen creation and landing zone optimisation. All complications were recognised and managed endovascularly and were observed only in non-acute dissections, although the sample size precluded meaningful assessment of any relationship between dissection phase and technical risk. These findings support TEAS as a feasible adjunct in carefully selected complex dissections and offer practical principles for safe adoption, and reflect an early experience that may be influenced by the learning curve of this technically demanding procedure.