Endovascular Septotomy During Thoracic Endovascular Aortic Repair for Chronic Dissection-Related Aneurysm: All That Glitters Is Not Gold.

Although endovascular repair is preferred over open techniques for chronic dissection-related thoracoabdominal aneurysms, specific adjunctive maneuvers are frequently required to optimize the distal landing zone of the thoracic endovascular aortic repair (TEVAR) or to enlarge the narrowed true lumen to deploy a branched endograft. Recently, transcatheter endovascular septotomy (TES) has gained attention as an evolving minimally invasive technique to optimize complex TEVAR procedures creating a better apposition of the endograft to the native aortic wall with the primary aim to block the retrograde perfusion of the false lumen. Initial results have been described satisfactory, but not negligible rates of intraprocedural complications in the form of lamella prolapse/migration leading to branch vessels occlusion have been described too. Herein we describe a complication that occurred after TEVAR with TES, causing static malperfusion of the reno-visceral vessels.