Acute iatrogenic type A aortic dissection following thoracic aortic endografting

Area of Science:

• Cardiovascular Surgery
• Vascular Endovascular Therapy
• Aortic Pathology

Background:

• Endovascular intervention offers a less invasive approach for thoracic aorta diseases.
• Thoracic endografting, while beneficial, carries risks including endoleaks, migration, and endograft collapse.
• Iatrogenic retrograde type A acute dissection (RTAAD) is an emerging and alarming complication of thoracic endografting.

Observation:

• This report details a case of iatrogenic RTAAD following endograft repair of a descending thoracic penetrating aortic ulcer.
• The complication necessitated emergent surgical replacement of the ascending aorta and aortic arch.
• A review of existing literature on RTAAD was conducted to identify predisposing factors and preventive measures.

Findings:

• RTAAD originates distally to the ascending aorta and progresses retrograde into it.
• Previously, RTAAD has been associated with conventional cardiac surgery, high mortality rates, aortic wall fragility, and Marfan disease.
• This case underscores the potential for RTAAD after endovascular repair of descending thoracic aortic pathologies.

Implications:

• Increased awareness of RTAAD as a complication of thoracic endovascular repair is crucial.
• Identifying predisposing factors and developing specific prevention strategies are essential for improving patient outcomes.
• Further research into the mechanisms and management of iatrogenic RTAAD is warranted.