# Zone 2.5 TEVAR with L-Shaped Marker-Guided Fenestration for Stanford Type B Aortic Dissection

## TL;DR

A new simplified TEVAR technique using a custom fenestration and L-shaped marker successfully treated a complex aortic dissection near the left subclavian artery.

## Contribution

A simplified, cost-effective Zone 2.5 TEVAR method using an L-shaped marker for fenestration alignment is introduced.

## Key findings

- The technique enabled accurate alignment with the left subclavian artery under fluoroscopic guidance.
- Postoperative and 6-month CT scans confirmed successful treatment outcomes.
- The approach is viable for high-risk patients with anatomically challenging aortic dissections.

## Abstract

A patient with complicated Stanford type B aortic dissection and a large ulcer-like projection just distal to the left subclavian artery (LSA) underwent thoracic endovascular aortic repair (TEVAR) using a physician-made 1-cm fenestration and L-shaped marker. This technique allowed accurate alignment with the LSA under fluoroscopic guidance without additional devices. Postoperative and 6-month follow-up computed tomography confirmed good outcomes. This simplified, economical Zone 2.5 TEVAR approach may be a viable treatment option for high-risk patients with anatomically challenging aortic dissections.