A modified squid capture technique for improved laser position during in situ fenestration.

In situ laser fenestration during thoracic endovascular aortic repair is effective and widely utilized, although achieving orthogonal laser alignment can be difficult in patients with complex aortic arch anatomy. A modification of the previously described "squid capture" technique is presented, employing a temporary, removable wire loop to stabilize a sheath against the endograft and facilitate perpendicular laser positioning. This approach minimizes intravascular manipulation, reducing the risk of embolic events, stroke, and arterial injury. A case involving a 60-year-old male with residual dissection and aneurysmal degeneration illustrates the technique's application. The method is simple, reproducible, and suited for challenging anatomy.