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International Young Surgeons Competition

IYSC02 - Electrocautery Septotomy for Endovascular Repair of Thoracic and Thoraco-abdominal Aortic Dissection (SEPTUM) early outcomes from a multicentre study

Thursday, June 5, 2025
1:35 PM – 1:40 PM CT
Location: Morial CC, Second Floor, Room 224
Objectives: Electrocautery septotomy, by connecting true and false aortic lumen, has been proposed to overcome limitations of thoracic and thoraco-abdominal aortic dissection endovascular repair. This study aimed to expand the limited body of evidence on outcomes of electrocautery septotomy in a multi-centre setting.

Methods: All consecutive patients, who underwent electrocautery septotomy for aortic dissection between July 2023 and November 2024 at five Italian aortic centres, were included in the present analysis. Endpoints consisted of septotomy technical success, procedural technical success, 30 days mortality, 30 days major adverse events and 30 days reinterventions. Aortic remodelling was analysed by comparing pre and post-operative CTA scan.

Results: A total of 29 patients underwent endovascular aortic repair with electrocautery septotomy for the following diseases: chronic type B dissection (10 patients, 34.5%), chronic residual dissection in previous ascending/arch repair (17 patients, 58.6%), subacute type B residual aortic dissection (1 patient, 3.4%) and acute type B dissection (1 patient, 3.4%). A 31% rate of urgent setting was reported.
The septotomy was performed at the level of the descending thoracic aorta in 3 patients (10.3%), in the infrarenal aorta-iliac segment in 1 patient (3.4%) and in the visceral aorta in 25 patients (86.2%) with various extensions (Table I).
All the patients after electrocautery septotomy received simultaneously an endovascular treatment, including FEVAR/BEVAR in 23 patients (79.3%), TEVAR in 5 patients (17.2%) and EVAR in 1 patient (3.4%).
Septotomy technical success was reported in all the patients except for one (96.6%) to whom aortic injury occurred during the lamella fenestration, requiring emergency thoracotomy. An 89.7% procedural technical success was attained. Two intraoperative renal artery occlusions ensued after the deployment of the endograft.
At 30 days, 4 patients (13.8%) had major adverse events (4 (13.8%) acute kidney injury, 2 (6.9%) pulmonary insufficiency and 1 (3.4%) spinal cord ischemia) and 1 death (3.4%) occurred in a patient who also experienced spinal cord ischemia (3.4%), treated in an urgent setting. Reinterventions were performed in 3 patients (10.3%): relining of iliac limb due to type Ib endoleak, mechanical thromboaspiration of renal artery stents and revision of the thoracic cavity after thoracotomy. At 1 month CTA scan, 6 (20.7%) type II endoleaks were observed. Positive aortic remodeling was reported in 21 patients (72.4%).

Conclusions: Electrocautery septotomy is s an effective adjunctive technique that facilitates the endovascular treatment of aortic dissections and ensures promising outcomes.