Retrograde Type A Aortic Dissection after Thoracic Endovascular Aortic Repair for Type B Dissection

Abstract

Background: A 64-year-old woman presented with dilatation of the distal aortic arch secondary to chronic type B aortic dissection. Case Report: The patient underwent fenestrated thoracic endovascular aortic repair (TEVAR) for closure of the entry site, and reconstruction of the left subclavian artery with a covered stent. On the 40th postoperative day, a retrograde type A aortic dissection (RTAD) was observed on computed tomography and she underwent emergency surgery. The entry tear, related to the proximal bare metal stent, was located in front of the aortic arch. A partial aortic arch replacement was performed. Conclusion: Consideration of the risk factors of RTAD is important when performing TEVAR.

Bentall procedure for retrograde type A dissection after endovascular repair in type A aortic dissection: A case report

“…That is, if the aortic wall is fragile and injured, the frozen elephant trunk stent is inserted into the descending aorta to strengthen it. [7][8][9] In the management of existing endografts, the appearance of a new tear in the fragile aortic wall during endograft removal must be considered, so in most cases, these endografts are left in place, and the frozen elephant trunk technique is omitted; however, the bare spring of the proximal endograft would be removed to create an appropriate distal plane. [6,7,10] However, the surgical management of RTAD after TEVAR for TAAD has seldom been reported.…”

“…[7][8][9] In the management of existing endografts, the appearance of a new tear in the fragile aortic wall during endograft removal must be considered, so in most cases, these endografts are left in place, and the frozen elephant trunk technique is omitted; however, the bare spring of the proximal endograft would be removed to create an appropriate distal plane. [6,7,10] However, the surgical management of RTAD after TEVAR for TAAD has seldom been reported. [11][12][13] In contrast to RTAD in TBAD, RTAD in TAAD requires the resolution of aortic arch and endograft lesions if total arch replacement is performed.…”

“…Lu et al [4] reported that the incidence of RTAD in TAAD was nearly 15%, while it was 1.3% to 8% in TBAD. [6,7] Several factors may contribute to these findings. First, the ascending aorta is subjected to high velocities and consequent shear stresses under pulsatile movements during the cardiac and respiratory cycles.…”

“…[7–9] In the management of existing endografts, the appearance of a new tear in the fragile aortic wall during endograft removal must be considered, so in most cases, these endografts are left in place, and the frozen elephant trunk technique is omitted; however, the bare spring of the proximal endograft would be removed to create an appropriate distal plane. [6,7,10]…”