Thoracic Endovascular Repair for Retrograde Type A Aortic Dissection: True Lumen Device Sizing

Optimal device sizing for retrograde type A aortic dissection during thoracic endovascular aortic repair (TEVAR) remains challenging because the true lumen at the proximal landing zone is frequently compressed and elliptical. This study evaluated the clinical outcomes and investigated how true lumen morphology influences device selection.

Between October 2012 and December 2022, 34 retrograde type A aortic dissection patients underwent TEVAR. Patients with major cardiac or neurological complications were excluded. We retrospectively analyzed the clinical and anatomical outcomes, focusing on postoperative remodeling. Preoperative computed tomography evaluated the relationship between the proximal landing true lumen morphology and device sizing.

The mean patient age was 62.7 ± 10.9 years. Emergency TEVAR was performed in 21 patients (61.8%) on the day of onset. Perioperative complications included one spinal cord infarction and no cerebral infarctions. Five patients required additional procedures for a residual entry flow. During the follow-up, the ascending aortic false lumen disappeared in 30 patients (88%). One in-hospital death occurred due to retrograde type A dissection related to stent-graft deployment. A proximal landing zone analysis showed frequently elliptical true lumens. The area-derived diameters tended to underestimate the size in highly elliptical lumens, whereas the major axis more closely corresponded to the selected device diameter.

TEVAR for retrograde type A aortic dissection is a feasible strategy with acceptable mid-to long-term outcomes in selected patients. Precise preoperative anatomical assessment and appropriate device sizing are essential to prevent complications. Evaluating the true lumen morphology at the proximal landing zone is critical for optimal device selection.