Retrograde type A dissection after endovascular stenting of the descending thoracic aorta. Is the risk real?
OBJECTIVE
Retrograde type A dissection during or after endoluminal graft repair of the descending thoracic aorta is a potentially lethal complication unique to thoracic endografting. Our aim is to increase its awareness and to review possible etiological factors.


METHODS
Two hundred and eighty-seven patients with different thoracic aortic pathologies were treated with endovascular prostheses over the last 6 years (February 2000 to March 2006) under a single-site protocol. A retrospective review was conducted to identify any retrograde aortic dissections by both chart and film review. Factors that may have contributed to its formation were also documented. This population was analyzed for the complication of retrograde aortic dissection as well as the factors related to its occurrence.


RESULTS
Seven patients (2.4%) with a gender distribution of three males and four females experienced a retrograde type A dissection within this sample at a median of 202 days. The mean age was 74 years (range 53-83). Aortic pathologies included aortic dissections (n=6) and thoracic aortic aneurysm (n=1). There were (n=3) 43% retrograde type A dissections identified within the perioperative period. Balloon angioplasty was performed in 71.4% (n=5). Two female patients (28.6%) had this event identified within their initial hospitalization with fatal consequences. Overall mortality was 57% (n=4) with extension of dissection the primary cause of death n=3 and open surgical repair (n=1) after an extension of retrograde dissection.


CONCLUSIONS
Female gender, use of stent-grafts for dissection and possible aggressive balloon angioplasty may play a role in the cause of retrograde type A dissection. A close surveillance program is recommended when using thoracic endografts outside the recommended device instructions for use.
Kpodonu
Jacques
J
Arizona Heart Institute, Department of Cardiovascular and Endovascular Surgery, 2632 N. 20th Street, Phoenix, AZ 85006, United States. jkpodonu@yahoo.com
Preventza
Ourania
O
Ramaiah
Venkatesh G
VG
Shennib
Hani
H
Wheatley
Grayson H
GH
Rodriquez-Lopez
Julio
J
Williams
James
J
Diethrich
Edward B
EB
D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000209:etiology* / Q000601:surgery; D000800:Angioplasty, Balloon / Q000009:adverse effects; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents