Retrograde type A dissection after thoracic endovascular repair due to the barb

We present a case of retrograde ascending aortic dissection in a 65-year-old man 8 months after emergency thoracic endovascular repair of an atherosclerotic aneurysm. Intraoperative findings identified a retrograde ascending aortic dissection due to the barb of the stent-graft. Retrograde type A dissection is a rare but fatal complication after thoracic endovascular aortic repair. There are some reports of retrograde ascending aortic dissection, but the etiology remains unclear. The subtle back-and-forth motion of the barb during the cardiac cycle may cause aortic injuries that result in retrograde ascending aortic dissection.