Combining fusion-imaging and intravascular ultrasound guidance to facilitate transcatheter electrosurgical septostomy through preexisting entry tears during endovascular repair of dissecting aneurysms

Transcatheter electrosurgical septotomy aids the adequate expansion of fenestrated or branched endografts in patients with a postdissection thoracoabdominal aortic aneurysm and a narrow true lumen. Still, the intraprocedural identifi-cation of preexisting reentry tears in the septum can be challenging and time consuming. We report four cases of post-dissection thoracoabdominal aortic aneurysms endovascular treatment, where computed tomography angiography fusion imaging was used during transcatheter electrosurgical septotomy in association with intravascular ultrasound examination, to improve precision in septum tear cannulation and favor procedural length and radiation exposure reduction. (J Vasc Surg Cases Innov Tech 2025;11:101818.)