Typical Retrograde Type A Dissection After Previous Type B Dissection
Typical RTAAD after previous TBAD
DOI:
https://doi.org/10.1532/hsf.3811Keywords:
aortic dissection, retrograde type A aortic dissection, surgeryAbstract
Background: Stanford type B aortic dissection (TBAD) retrograde tears to Stanford type A AD (RTAAD) have been reported only rarely, but are often fatal. Early diagnosis and timely surgery are essential. We present a typical case of RTAAD after the tip of the stent directly damaged the ascending aorta wall.
Case: A 71-year-old woman was admitted to our department for chest pain and back pain for 10 hours. She had undergone coated stent graft implantation surgery a month previously for TBAD. On first impression, we suspected the AD may have progressed or torn retrogradely. RTAAD was confirmed by computed tomography angiography, and we successfully performed open surgery.
Conclusion: RTAAD should be suspected in patients with chest and back pain after endovascular stent repair. Prompt recognition is essential, and early surgical treatment is strongly recommended.
References
Al-Kalei AMA, Wu Z, Zhang H. Influence of primary intimal tear location in type B aortic dissection as a factor portending retrograde type A aortic dissection after endovascular repair. J Vasc Interv Radiol 2018;29:833-840.e2.
An Z, Song Z, Tang H, Han L, Xu Z. Retrograde type A dissection after thoracic endovascular aortic repair: Surgical strategy and literature review. Heart Lung Circ 2018;27:629-634.
Canaud L, Ozdemir BA, Patterson BO, et al. Retrograde aortic dissection after thoracic endovascular aortic repair. Ann Surg 2014;260:389-395.
Chen Y, Zhang S, Liu L, et al. Retrograde type A aortic dissection after thoracic endovascular aortic repair: A systematic review and meta-analysis. J Am Heart Assoc 2017;6:e004649.
Dong ZH, Fu WG, Wang YQ, et al. Retrograde type A aortic dissection after endovascular stent graft placement for treatment of type B dissection. Circulation 2009;119:735-741.
Dong Z, Fu W, Wang Y, et al. Stent graft-induced new entry after endovascular repair for Stanford type B aortic dissection. J Vasc Surg 2010;52:1450-1457.
Gorlitzer M, Weiss G, Moidl R, et al. Repair of stent graft-induced retrograde type A aortic dissection using the E-vita open prosthesis. Eur J Cardiothorac Surg 2012;42:566-570.
Khoynezhad A, White RA. Pathogenesis and management of retrograde type A aortic dissection after thoracic endovascular aortic repair. Ann Vasc Surg 2013;27:1201-1206.
Kim JB, Choo SJ, Kim WK, et al. Outcomes of acute retrograde type A aortic dissection with an entry tear in descending aorta. Circulation 2014;130: S39-S44.
Kpodonu J, Preventza O, Ramaiah VG, et al. Retrograde type A dissection after endovascular stenting of the descending thoracic aorta. Is the risk real? Eur J Cardiothorac Surg 2008;33:1014-1018.
Nauta FJ, Tolenaar JL, Patel HJ, et al. Impact of retrograde arch extension in acute type B aortic dissection on management and outcomes. Ann Thorac Surg. 2016;102:2036-2043.
Neuhauser B, Czermak BV, Fish J, et al. Type A dissection following endovascular thoracic aortic stent-graft repair. J Endovasc Ther 2005;12:74-81.
Neuhauser B, Greiner A, Jaschke W, et al. Serious complications following endovascular thoracic aortic stent-graft repair for type B dissection. Eur J Cardiothorac Surg 2008;33:58-63.
Williams JB, Andersen ND, Bhattacharya SD, et al. Retrograde ascending aortic dissection as an early complication of thoracic endovascular aortic repair. J Vasc Surg 2012;55:1255-1262.
Yammine H, Briggs CS, Stanley GA, et al. Retrograde type A dissection after thoracic endovascular aortic repair for type B aortic dissection. J Vasc Surg 2019;69:24-33.
