Pathogenesis and management of retrograde type A aortic dissection after thoracic endovascular aortic repair

Retrograde 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.

A 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.

The 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.

Retrograde 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.