Management of Retrograde Dissection Complicating Thoracic Endovascular Aortic Repair

Abstract

Background: Retrograde type A aortic dissection is a challenging surgical emergency associated with high morbidity and mortality. Objective: The aim of this study was to describe our experience with retrograde type A aortic dissection (RAAD) following thoracic endovascular aortic repair (TEVAR) and its surgical management strategy. Patients and Methods:Our study was conducted between January 2011 and January 2021 at Cairo University Hospitals, and included 100 patients undergoing (TEVAR) to highlight the management of retrograde dissection complicating the procedure. The mean age was 55 ± 9 years and 76% of patients were males. All retrograde dissection patients underwent emergency surgical repair. Results: The in-hospital mortality was 10% of patients who had RAAD and occurred in one patient who suffered from fatal hematemesis postoperatively. The mean cross clamp time was 93±17 minutes and circulatory arrest time was 25±6 minutes. One patient also suffered from acute renal failure requiring hemodialysis during the postoperative hospital stay. Conclusions: Retrograde type A aortic dissection is an uncommon but potentially catastrophic complication of TEVAR. Surgical replacement of ascending aorta and a segment of aortic arch involving the entry tear offers an efficient strategy