title: Repair of stent graft-induced retrograde type A aortic dissection using the E-vita open prosthesis.
abstract: OBJECTIVE
  Stent graft-induced retrograde type A dissection is a life-threatening complication after endovascular treatment of acute aortic type B dissections.
  
  
  METHODS
  From August 2005 to February 2011, retrograde aortic dissection occurred in 4 of 29 patients (13.8%) undergoing thoracic endovascular aortic repair (TEVAR) for acute complicated aortic type B dissection. Three patients underwent emergent surgical conversion immediately after TEVAR. The operative strategy was a combined surgical and endovascular approach (frozen elephant trunk technique) using a specially designed hybrid prosthesis (Jotec E-vita open). All operations were performed under moderate hypothermia (25-28°C) and selective bilateral antegrade cerebral perfusion. The mean duration of circulatory arrest was 56 ± 7 min. Operative data and the outcome of surgery were analysed retrospectively. Data were analysed retrospectively in the limited number of patients.
  
  
  RESULTS
  All patients survived the surgical procedure. No stroke, paraplegia, renal failure or other major complications occurred. Postoperative CT scans revealed perigraft thrombus formation and stable aortic dimensions in all patients after 6 months. In one patient, the retrograde dissection remained primarily undetected and untreated. The patient died suddenly, with no clinical signs, within 7 days after stent graft implantation. Autopsy revealed cardiac tamponade due to retrograde type A aortic dissection.
  
  
  CONCLUSIONS
  Retrograde aortic dissection type A is a serious complication of thoracic endovascular repair of acute aortic type B dissection. Despite the small number of patients investigated in this study, the frozen elephant trunk technique appears to be a feasible bail-out strategy for the treatment of these acute aortic events.
authors.affiliation: Department of Cardiovascular Surgery, Hospital Hietzing, Vienna, Austria. michael.gorlitzer@wienkav.at
authors.forename: Michael
authors.initials: M
authors.lastname: Gorlitzer
authors.forename: Gabriel
authors.initials: G
authors.lastname: Weiss
authors.forename: Reinhard
authors.initials: R
authors.lastname: Moidl
authors.forename: Sandra
authors.initials: S
authors.lastname: Folkmann
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Waldenberger
authors.forename: Martin
authors.initials: M
authors.lastname: Czerny
authors.forename: Martin
authors.initials: M
authors.lastname: Grabenwöger
mesh_terms: D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D017130:Angioplasty / Q000009:adverse effects* / Q000379:methods; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D002423:Cause of Death; D015331:Cohort Studies; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D011474:Prosthesis Design; D012086:Reoperation / Q000379:methods / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D015607:Stents / Q000009:adverse effects; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome