Retrograde Ascending Aortic Dissection After Thoracic Endovascular Aortic Repair for Distal Aortic Dissection or With Zone 0 Landing: Association, Risk Factors, and True Incidence

Abstract

We attempted to determine the true incidence of retrograde ascending aortic dissection (rAAD) and to challenge its reported association with distal aortic dissection or zone 0 deployment. From January 2005 to August 2014, 305 patients who were at risk for rAAD underwent thoracic endovascular aortic repair. We excluded patients with prior ascending, hemiarch, or traditional or frozen elephant trunk grafts, or who required concomitant ascending graft placement. Patients in group A (n= 111, 36.4%) had distal aortic dissection or hematoma (n= 75, 67.6%) or required landing of the endograft in zone 0 of the native ascending aorta (n= 36, 32.4%). Patients in group B (n= 194, 63.6%) had nondissected descending or distal arch aneurysm (n= 172), penetrating ulcer (n= 9), coarctation (n= 6), endoleak not caused by dissection (n= 3), aortobronchial fistula (n= 3), or transection (n= 1). The incidence of rAAD was 1.3% overall (n= 4), 0.9% in group A (n= 1, Cook Zenith TX2), and 1.5% in group B (n= 3; 1 Talent Captivia, 2 Cook Zenith TX2; p= 0.64). No zone 0-treated patient had rAAD. Two patients from group B died, and 1 was treated nonoperatively. The median interval between thoracic endovascular aortic repair and rAAD was 11 days (range, 0 to 90 days). Post-thoracic endovascular aortic repair rAAD is a rare but lethal complication. Operator experience is crucial for prompt recognition and prevention. It does not appear that rAAD is specifically associated with distal aortic dissection or landing in zone 0. To our knowledge, this is one of the few studies to report the true incidence of rAAD in at-risk patients.