We present a case of retrograde ascending aortic dissection in a 65-year-old man 8 months after emergency thoracic endovascular repair of an atherosclerotic aneurysm. Intraoperative findings identified a retrograde ascending aortic dissection due to the barb of the stent-graft. Retrograde type A dissection is a rare but fatal complication after thoracic endovascular aortic repair. There are some reports of retrograde ascending aortic dissection, but the etiology remains unclear. The subtle back-and-forth motion of the barb during the cardiac cycle may cause aortic injuries that result in retrograde ascending aortic dissection.
KpodonuJPreventzaORamaiahVG. Retrograde type A dissection after endovascular stenting of the descending thoracic aorta. Is the risk real?. Eur J Cardiothorac Surg2008; 33: 1014–1018.
2.
EggebrechtHThompsonMRousseauH. Retrograde ascending aortic dissection during or after thoracic aortic stent graft replacement: insight from the European Registry on Endovascular Aortic Repair Complications. Circulation2009; 120: S276–S281.
3.
CzernyMBavariaJEWeigangE. Targeting landing zone 0 by total arch rerouting and TEVAR: midterm results of a transcontinental registry. Ann Thorac Surg2012; 94: 84–89.
4.
Canaud L, Ozdemir BA, Patterson BO, Holt PJ, Loftus IM, Thompson MM. Retrograde aortic dissection after thoracic endovascular aortic repair. Ann Surg 2014 Jan 16. [Epub ahead of print].
5.
LuehrMEtzCDLehmkuhlL. Surgical management of delayed retrograde type A aortic dissection following complete supra-aortic de-branching and stent-grafting of the transverse arch. Eur J Cardiothorac Surg2013; 44: 958–963.
SvenssonLGLabibSBEisenhauerACButterlyJR. Intimal tear without hematoma. An important variant of aortic dissection that can elude current imaging techniques. Circulation1999; 99: 1331–1336.
