Chronic aortic dissections (AD) are defined as dissections lasting > 90 days after the onset of symptoms (Fig. 1). Chronic ADs can have severe complications, such as aneurysm, chronic pain, persistent malperfusion, or rupture. Thoracic endovascular aortic repair (TEVAR) is one of the recommended treatments for complicated chronic AD [1]. TEVAR in chronic AD is plagued with technical challenges of rupture and endoleaks due to the thickened, calcified, and immobile dissection flap. Furthermore, exclusion of the false lumen (FL) may cause ischemia to distal branch arteries. This is particularly important as 87% of the chronic dissections extend beyond the celiac trunk [2]. These challenges contribute to a technical failure rate of 1/10 chronic AD TEVAR procedures [3]. Surgeons have been left looking for other options.
There have been a series of reports investigating the use of dissection flap fenestration to improve the distal...
