title: Retrograde type A aortic dissection after endovascular stent graft placement for treatment of type B dissection.
abstract: BACKGROUND
  Retrograde type A aortic dissection has been deemed a rare complication after endovascular stent graft placement for type B dissection. However, this life-threatening event appears to be underrecognized and is worth being investigated further.
  
  
  RESULTS
  Eleven of 443 patients developed retrograde type A aortic dissection during or after stent grafting for type B dissection from August 2000 to June 2007. Of these 11 patients, 3 had Marfan syndrome. The Kaplan-Meier estimate of the rate of freedom from this event at 36 months is 97.4% (95% confidence interval, 0.95 to 0.99). The new entry was located at the tip of the proximal bare spring of the stent graft in 9 patients, was within the anchoring area of the proximal bare spring in 1, and remained unknown in 1 patient. Eight patients were converted to open surgery, and 2 received medical treatment. One patient suddenly died 2 hours after the primary stent grafting, and 2 died within 1 week after the surgical conversion, so mortality reached 27.3%. During the follow-up from 3 to 50 months, type I endoleak was identified in 1 patient 3 months after the surgical exploration and disappeared at 6 months.
  
  
  CONCLUSIONS
  Retrograde type A aortic dissection after stent grafting for type B dissection appears not to be rare and results from mixed causes. Fragility of the aortic wall and disease progression may predispose to it, whereas stent grafting-related factors make important and provocative contributions. Avoiding aortic arch stent grafting in Marfan patients, preferably selecting the endograft without the proximal bare spring for patients with a kinked aortic arch or with Marfan syndrome (if endografting is used), improving the device design, and standardizing endovascular manipulation might lessen its occurrence.
authors.affiliation: Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Zhi Hui
authors.initials: ZH
authors.lastname: Dong
authors.forename: Wei Guo
authors.initials: WG
authors.lastname: Fu
authors.forename: Yu Qi
authors.initials: YQ
authors.lastname: Wang
authors.forename: Da Qiao
authors.initials: DQ
authors.lastname: Guo
authors.forename: Xin
authors.initials: X
authors.lastname: Xu
authors.forename: Yuan
authors.initials: Y
authors.lastname: Ji
authors.forename: Bin
authors.initials: B
authors.lastname: Chen
authors.forename: Jun Hao
authors.initials: JH
authors.lastname: Jiang
authors.forename: Jue
authors.initials: J
authors.lastname: Yang
authors.forename: Zhen Yu
authors.initials: ZY
authors.lastname: Shi
authors.forename: Ting
authors.initials: T
authors.lastname: Zhu
authors.forename: Yun
authors.initials: Y
authors.lastname: Shi
mesh_terms: D000328:Adult; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D001027:Aortography; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008382:Marfan Syndrome / Q000150:complications; D008875:Middle Aged; D011183:Postoperative Complications; D015607:Stents / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed