Electrosurgical In Situ Fenestration of Aortic Endograft.

Purpose: Endovascular interventions have become the primary choice for treating complex aortic pathologies, particularly with the use of fenestrated and branched endografts. However, limitations, such as manufacturing time have restricted their applicability in urgent situations. This has led to explore alternative off-the-shelf solutions, including in situ fenestration. Within this technical note, we describe technical aspects of in situ fenestration using electrosurgical guidewire, in both antegrade and retrograde approaches, explaining advantages and limitation compared with other in situ fenestration techniques.

Technique: The technique involves standard main body endograft deployment followed by targeted in situ fenestration using an electrified guidewire. Two illustrative cases are presented to demonstrate the technical aspects and clinical outcomes of this procedure.

Conclusion: Electrosurgical in situ fenestration emerges as an effective technique for urgent treatment of complex aortic diseases. Further research is warranted to validate its safety and durability in larger patient cohorts.

Clinical impact: Electrosurgical in situ fenestration allows to expand the feasibility of complex endovascular repairs in emegency settings. Electrosurgical in situ fenestration combines the benefits of thermal methods, offering broad availability and lower costs. Compared to other in situ fenestration techniques, the proposed technology allows for the creation of extremely small fenestrations with minimal and precise tissue disruption.