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[Retrograde Ascending Aortic Dissection during Thoracic Endovascular Stent Graft Repair: A Case Report]
Insights
Thoracic endovascular aortic repair (TEVAR) can lead to retrograde ascending aortic dissection (rAAD). This case highlights a rare but serious complication of TEVAR, emphasizing the need for vigilance during the procedure.
Area of Science:
- Cardiovascular Surgery
- Vascular Endovascular Therapy
- Aortic Disease Management
Background:
- Chronic aortic dissection (DeBakey IIIa) management often involves thoracic endovascular aortic repair (TEVAR).
- TEVAR is considered a less invasive alternative to open surgical repair for aortic dissections.
- Patient presented with hypertension and chronic aortic dissection, necessitating intervention.
Observation:
- A 66-year-old male underwent TEVAR using a Zenith TX2 stent graft.
- Post-deployment angiography revealed compromised blood flow in the brachiocephalic and left common carotid arteries.
- Immediate transfer to the operating room was required due to the observed complication.
Findings:
- Intraoperative findings confirmed a retrograde ascending aortic dissection (rAAD) after stent graft placement.
- The complication occurred despite no significant changes in vital signs initially.
- Ascending-arch vascular prosthesis was performed under circulatory arrest to address the rAAD.
Implications:
- TEVAR, while minimally invasive, carries the risk of inducing serious complications like rAAD.
- This case underscores the importance of meticulous intraoperative monitoring and prompt management of unexpected findings during TEVAR.
- Awareness of potential TEVAR-induced dissections is crucial for improving patient outcomes in aortic disease treatment.
Abstract:
A 66-year-old man (166 cm and 64 kg) with a history of hypertension was diagnosed with a.chronic aortic dissection (DeBakey IIIa type). He underwent thoracic endovascular aortic repair (TEVAR) under general anesthesia (sevoflurane and remifentanil) in an angiography room. After deploying a stent graft (Zenith TX2, Cook Japan, Tokyo) in the descending aorta via the right femoral artery, we checked the condition of the stent by angiography. No remarkable change of vital signs was observed. However, the angiography revealed a decrease in blood flow of both brachiocephalic and left common carotid arteries. The decision was made to operate immediately. The patient was transferred to the operating room under sedation with propofol. Cardiopulmonary bypass commenced 1 hour and 25 minutes after the decision to operate. Exploration of the aortic arch confirmed a retrograde ascending aortic dissection (rAAD). Ascending-arch vascular prosthesis was performed during circulatory arrest. The patient was extubated successfully the day after surgery. The present case demonstrates an intraoperative rAAD following stent placement TEVAR is believed to be less invasive compared to surgical treatment. However, it should be noted that TEVAR could provoke life-threatening complications such as rAAD.
