Retrograde Type A Dissection after Thoracic Endovascular Aortic Repair: Surgical Strategy and Literature Review

Background: In this study, we investigated the surgical strategy for managing retrograde type A dissection (RTAD) after thoracic endovascular aortic repair (TEVAR) by reporting our experience and literature review.

Methods: From June 2011 to January 2014, nine patients with RTAD received surgical repair in our institution. The mean age of these patients was 49.3±10.7 years. Data on these RTAD patients was retrospectively collected for further analysis. Literature related to RTAD after TEVAR from 2006 to 2014 was reviewed using the following terms: thoracic endovascular aortic repair, retrograde type A dissection, stent induced new entry, and surgical repair.

Results: We adopted a total arch replacement combined with a stented elephant trunk implantation and partly preserved the previous TEVAR stent during operation. In-hospital death rate was 11.1% (one of nine). One patient (11.1%) developed paraparesis after operation. No late deaths or complications occurred during follow-up. Literature review identified four articles on the surgical management of RTAD after TEVAR. Our literature review also showed total arch replacement with the stented elephant trunk implantation might be associated with a better prognosis.

Conclusions: Retrograde type A dissection is a serious complication after TEVAR. The induced factors of RTAD were various and complicated. Our experience and literature review indicates a combination of total arch replacement, stented elephant trunk implantation and partly preserving the previous TEVAR stent is feasible for the surgical repair of RTAD after TEVAR.