# Total Endovascular Aortic Repair in a Jehovah’s Witness Due to Chronic Postdissection Aortic Aneurysm with Endovascular Aortic Septotomy with Electrosurgery

## TL;DR

A Jehovah’s Witness patient underwent total endovascular aortic repair using innovative techniques to avoid blood transfusions, successfully treating a complex aortic aneurysm.

## Contribution

Demonstrates the feasibility of combining endovascular aortic septotomy and electrosurgery for aortic repair in patients refusing blood transfusions.

## Key findings

- Total endovascular repair was successfully completed using multiple techniques without open surgery or blood transfusions.
- Two type II endoleaks were effectively treated with percutaneous embolization.
- The patient showed good recovery and no neurological complications at follow-up.

## Abstract

A 63-year-old male Jehovah’s Witness with a history of Stanford type B aortic dissection presented after a stable course over the 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 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.

Open surgical treatment of aortic pathologies involving the aortic arch is highly invasive, requiring cardiopulmonary bypass and blood transfusions.