Re-entry catheter-guided in situ fenestration to preserve the left subclavian artery during thoracic endovascular aortic repair for subacute type B aortic dissection

We describe the use of the BeBack re-entry catheter as an alternative tool for in situ fenestration during thoracic endovascular aortic repair in a patient with subacute type B aortic dissection requiring zone 2 landing. A 69-year-old woman with high-risk imaging features underwent thoracic endovascular aortic repair with intentional coverage of the left subclavian artery. Via percutaneous left brachial access, a deflectable 7F introducer was positioned against the outer curvature of the thoracic endograft. Retrograde puncture was performed using a 4F × 120 cm BeBack re-entry catheter under angiographic guidance in orthogonal projections to ensure precise orientation and penetration. After successful crossing of the endograft fabric, an 0.018″ guidewire was advanced into the ascending aorta, followed by sequential dilation and deployment of a balloon-expandable stent. Final angiography confirmed patency of the target vessel and exclusion of the false lumen.