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

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.