title: Retrograde type B aortic dissection as a complication of standard endovascular aortic repair.
abstract: Endovascular repair (EVAR) for abdominal aortic aneurysms (AAAs) is becoming the standard of practice in most vascular centers, even if some concerns remain about the occurrence of early and long-term failure and reintervention. A rare but potential catastrophic event is represented by retrograde type B aortic dissection (RTBAD). We report 2 cases of RTBAD after 425 standard EVARs performed in our institution. Both patients were treated for AAA without perioperative complication, and in both the patients, the presence of a preexisting disease of the thoracic aortic wall (ulcerated plaque in 1 case and aortic ectasia in the other) may have played an important role in the rapid evolution toward an early onset of the dissection. Only few cases of type B dissection after EVAR have been reported in literature, and the etiology of this complication remains uncertain. For the first time, our experience highlights the possible etiologic role of preexisting lesions of the thoracic aorta. In these cases, the only possible strategy may be to carefully study the entire aorta before an EVAR procedure, eventually switching the indication to an open surgical repair or carrying out a more aggressive management, treating the defects of the thoracic aorta.
authors.affiliation: Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy. Electronic address: sirignanop@alice.it.
authors.forename: Pasqualino
authors.initials: P
authors.lastname: Sirignano
authors.affiliation: Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Pranteda
authors.affiliation: Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Capoccia
authors.affiliation: Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy.
authors.forename: Danilo
authors.initials: D
authors.lastname: Menna
authors.affiliation: Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy.
authors.forename: Wassim
authors.initials: W
authors.lastname: Mansour
authors.affiliation: Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Speziale
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D057510:Endovascular Procedures / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome