A case of late retrograde type A aortic dissection after hybrid aortic arch repair

Retrograde type A aortic dissection (RTAD) after thoracic endovascular aortic repair (TEVAR) is a rare but potentially fatal complication. We report a case of very late-onset RTAD occurring 9 years after hybrid aortic arch repair. An 81-year-old man with a history of TEVAR with cervical debranching for subacute thrombosed RTAD, which later developed an ulcer-like projection, presented with dizziness and back pain. Acute RTAD with cardiac tamponade was diagnosed, and emergent ascending aortic replacement with resection of the entry tear-located at the proximal edge of the stent on the lesser curvature-was performed. Postoperatively, the patient required prolonged ventilatory support for respiratory failure and developed pyothorax secondary to aspiration pneumonia. He was ultimately discharged home on postoperative day 188 after rehabilitation. This case underscores the importance of a distinct pathophysiology in late RTAD, in which progressive aortic wall degeneration and biomechanical fatigue over time-rather than procedural factors-may contribute to dissection. Continuous imaging surveillance and strict cardiovascular risk factor management are essential, even in the absence of early complications.