Pathogenesis and Management of Retrograde Type A Aortic Dissection After Thoracic Endovascular Aortic Repair

BackgroundRetrograde type A aortic dissection is a feared complication of thoracic aortic endografting. The aim of this study was to review the incidence, etiology, and management of this life-threatening complication.MethodsA retrospective analysis of the literature in the last 10 years was performed. Data on retrograde type A aortic dissection from this literature search, along with authors’ personal experience, provided the basis for this review.ResultsThe incidence of retrograde type A aortic dissection ranges from 1.3% to 6.8%. In is most commonly associated with endografting of acute or chronic aortic dissection. Up to one third of patients will have this complication 3 months or later after the index procedure. Open surgical repair remains the “gold standard” for retrograde type A aortic dissection, although medical and endovascular approaches may be utilized in selected patients with prohibitive operative risk. Mortality remains high ranging from 20% to 57%. Potential etiologies of retrograde type A aortic dissection include aortic injury from catheter and wire or stent graft manipulation, poor perioperative antihypertensive control, inappropriate patient and device selection, aggressive balloon dilation, and stent graft oversizing.ConclusionsRetrograde type A aortic dissection remains a deadly complication of thoracic aortic endografting. The high incidence of delayed type A aortic dissection underscores the importance of imaging follow-up in patients undergoing a thoracic endograft procedure.