Techniques for repair of retrograde aortic dissection following thoracic endovascular aortic repair

The advances in thoracic endovascular aortic repair (TEVAR) offer patients who are otherwise unsuitable for open surgery an alternative in treating their aortic arch pathologies. However, the adoption of TEVAR carries inherent complications unique to itself, notably the occurrence of Type A retrograde ascending aortic dissections, which can range from 1-3%. Several key technical considerations are must be heeded to minimize the risks of these complications. It is important to completely excise the primary entry tear through a careful and methodical approach. The proximal and distal reconstruction must be hemodynamically sound, with care taken to stabilize both the root and the distal aorta. Neuroprotection strategies, such as antegrade cerebral perfusion, should be utilized if the duration of circulatory arrest is anticipated to be greater than 30 minutes. This report details the operative techniques for the repair of retrograde aortic dissections following TEVAR.