Bilateral Central Retinal Artery Occlusion Immediately After Thoracic Endovascular Aortic Repair

Although complications of thoracic endovascular aortic repair (TEVAR), such as spinal cord ischemia and peripheral embolism, are well known, there have been no previous reports of central retinal artery occlusion (CRAO).

A 69-year-old man was transferred to our hospital with abdominal pain and diagnosed with combined type B aortic dissection and abdominal aortic aneurysm. Endovascular repair for abdominal aortic aneurysm was initially performed. After TEVAR for primary entry closure, he reported bilateral vision loss. Ophthalmological examination diagnosed bilateral CRAO. After prompt treatment, the patient's vision recovered to its preoperative level.

In this case, it is conceivable that a microembolism was dispersed into the head and neck vasculature, leading to occlusion at the level of the central retinal artery. Furthermore, the left subclavian artery was partially covered, suggesting that reduced perfusion reserve in the posterior circulation may have lowered the ischemic tolerance of retinal tissue, thereby amplifying the clinical impact of microemboli reaching the ocular circulation.

Complete visual recovery in bilateral CRAO is extremely rare, and this case is considered an important example demonstrating the value of early diagnosis and treatment after TEVAR.