An Asymptomatic Case of Type B Aortic Dissection Developing Type A Dissection During Interfacility Transfer: A Case...

During the transfer from a hospital to a tertiary hospital, patients with acute aortic dissection can deteriorate due to aortic rupture or extension of the dissection. Particularly when type B aortic dissection progresses to type A dissection, it can lead to serious complications. This case report that a 50-year-old man who was transferred to our institute for thoracic endovascular aortic repair for complicated acute type B aortic dissection developed retrograde type A aortic dissection and was successfully treated with total arch replacement using a frozen elephant trunk. The patient experienced retrograde type A aortic dissection during transfer for treatment of complicated type B aortic dissection while no changes in hemodynamics or symptoms were observed. After arrival at our institution, open surgical repair with total arch replacement using the frozen elephant trunk technique successfully treated the entry closure in the proximal descending aorta. The intraoperative direct echography showed no intimal tears in the ascending aorta, so total arch replacement using a frozen elephant trunk was chosen. The patient survived without any evident complications and was cured with satisfactory outcomes at a 5-year follow-up. Aortic dissection can worsen even when a patient has no symptoms or hemodynamic changes. When transferring a case of aortic dissection, caution is required regarding progression of dissection. Total arch replacement using a frozen elephant trunk for retrograde aortic dissection is effective in resecting intimal tears.