Total endovascular aortic repair in a Jehovah's Witness due to chronic postdissection aortic aneurysm with endovascular aortic septotomy with electrosurgery

A 63-year-old male Jehovah's Witness with history of Stanford type B aortic dissection, presented after a stable course over years with a rapid expansion of the thoraco-abdominal aorta, necessitating intervention. Due to religious beliefs prohibiting blood transfusions, open surgical treatment of the aortic arch was not viable. Instead, endovascular aortic septotomy with electrosurgery (EASE) of the abdominal aorta and endovascular repair of the aortic arch were successfully performed, followed by thoracic endovascular aortic repair to ensure sufficient lumen expansion for further prosthetic deployment. Five months later the total endovascular repair of the aorta was completed by fenestrated endovascular aortic repair. Two type II endoleaks in the thoracic and abdominal aorta were treated with a percutaneous embolization. The patient remained in good general condition at the follow-up examinations, with no neurological abnormalities. The case highlights the feasibility and advantages of established and emerging endovascular techniques as alternative to open aortic surgery for patients who refuse blood transfusions.