Electrified Wire In Situ Fenestration: A Novel Approach for Endovascular Repair of Type B Aortic Dissection with Aberrant Right Subclavian Artery

The coexistence of Stanford type B aortic dissection (TBAD) and aberrant right subclavian artery (ARSA) is rare and technically challenging for thoracic endovascular aortic repair (TEVAR), particularly due to the need for branch preservation. We describe the first use of electrified wire in situ fenestration (EWISF) in a 50-year-old female with TBAD, ARSA, and Kommerell's diverticulum. TEVAR using a single-branched endograft preserved left subclavian artery patency, while EWISF achieved endograft fenestration to maintain ARSA perfusion. Final imaging confirmed successful dissection repair and branch patency without complications. This approach offers a novel, resource-efficient solution for anatomically complex aortic dissections requiring branch preservation.