Endovascular Aortic Septotomy with Electrosurgery … A Breakthrough in the Treatment of Aortic Dissection

Aortic dissection is one of the most acute life-threatening diseases. Despite improvements in diagnostics, medical therapy, and surgical technique, patient mortality and morbidity remain high. Through negative remodelling, chronic thoracoabdominal type B aortic dissection (TBAD) leads to aneurysmal degeneration and potential organ malperfusion, necessitating further therapeutic intervention. Surgical replacement of the ascending aorta with resection of the entry site is the treatment of choice. A residual dissection membrane with a false lumen remains afterwards. As a result, a proportion of patients will develop post-dissection aneurysms. Furthermore, a narrow true lumen does not allow endograft release because of the risk of aortic obstruction. As a ground-breaking advancement in the treatment, we developed a novel approach, the Endovascular Aortic Septotomy with Electrosurgery (EASE) technique. It involves cutting the dissection membrane longitudinally to create a single, common lumen from both the true and false lumen, thereby facilitating stent graft placement. With the proposed project, we will develop a catheter-based device to perform neo-fenestration and septotomy using electrosurgical cutting techniques in a single procedure. The incorporation of an integrated guiding and stabilization mechanism minimizes the risk of iatrogenic injury to the aortic wall. This system significantly enhances procedural safety, efficacy, and ease of use in the endovascular treatment of chronic thoracoabdominal type B aortic dissections making palliative untreatable patients curatively treatable. Furthermore, an aortic test setup will be developed to enable clinical personnel simulating the surgical procedure under real conditions to facilitate preoperative practice in a controlled environment.