Thermal septotomy complications and management of residual septum visceral ostial occlusions.

A 61-year-old man with a previous total arch reconstruction with frozen elephant trunk presented with an expanding descending thoracic aortic aneurysm in the setting of a residual chronic type B aortic dissection. Thoracic endovascular aortic repair facilitated by thermal septotomy was complicated by left renal ostial occlusion from a dynamic postseptotomy dissection flap, manifesting as flank pain and elevated creatinine, both of which improved (creatinine decreased to 1.75 from 2.2 mg/dL) following revisional trans-septal left renal artery stenting. This case highlights that dynamic dissection flaps following septotomy may lead to visceral vessel ostial occlusion and can be successfully treated with trans-septal stenting.