Retrograde type A dissection after thoracic endovascular aortic repair for type B aortic dissection

Area of Science:

• Cardiovascular Surgery
• Endovascular Repair
• Aortic Dissection

Background:

• Type B aortic dissection (TBAD) is a serious condition requiring timely intervention.
• Thoracic endovascular aortic repair (TEVAR) is a common treatment for TBAD.
• Retrograde type A dissection (RTAD) is a potential complication following TEVAR for TBAD.

Purpose of the Study:

• To investigate the clinical, anatomic, and procedural characteristics of patients who develop RTAD after TEVAR for TBAD.
• To identify risk factors associated with RTAD development.
• To evaluate outcomes including survival and reintervention rates in patients with and without RTAD.

Main Methods:

• Retrospective analysis of 186 patients who underwent TEVAR for TBAD between 2012 and 2017.
• Comparison of 15 patients who developed RTAD with 171 patients who did not.
• Kaplan-Meier survival analysis and assessment of reintervention rates.

Main Results:

• The incidence of RTAD was 8%. RTAD patients had significantly lower survival rates (P=.04) and a higher need for reintervention (50% survival post-reintervention).
• RTAD was associated with proximal landing zones in zones 0, 1, or 2 (93%), aortic diameter ≥40 mm (47%), and presence of renal ischemia (P=.04).
• Partial/complete false lumen thrombosis was more frequent in RTAD patients (P=.03). RTAD occurred even after one year post-TEVAR.

Conclusions:

• RTAD after TEVAR for TBAD is linked to specific proximal landing zones and aortic diameter, not demographics.
• Patients with RTAD often present with renal ischemia and false lumen thrombosis.
• Long-term monitoring is essential for TBAD patients treated with TEVAR due to the possibility of late RTAD development.