Type A Aortic Dissection After Thoracic Endovascular Aortic Repair.
BACKGROUND
Type A aortic dissection (TAAD) is a rare complication associated with thoracic endovascular aortic repair (TEVAR). Although TAAD can result in catastrophic outcomes, the pathology of the condition has not been thoroughly clarified yet.


METHODS
We retrospectively reviewed details from the medical records of 546 patients with diseases of the thoracic aorta (thoracic aortic aneurysm, n = 362; aortic dissection, n = 178; and fistula between the descending thoracic aorta and esophagus, n = 6) who underwent TEVAR in five hospitals from May 1997 through February 2015 to identify patients in whom TAAD developed during or after TEVAR.


RESULTS
TEVAR-associated TAAD developed in 12 patients (2.2%). Pathologies originally treated with TEVAR were aortic dissection in 10 patients (83%) and true thoracic aortic aneurysm in 2 (17%). Type A aortic dissection developed during hospitalization in 4 patients (33%), within 1 year in 5 (42%), and more than 1 year later in 3 (25%). The entry tear was located in the ascending aorta or the aortic arch away from the edges of stent grafts in 8 patients (67%), whereas it was found just at the proximal edges of stent grafts in 4 patients (33%). Nine patients underwent ascending aortic replacement with or without concomitant aortic arch replacement, and 3 patients underwent medical management. Overall, 2 patients (17%) died during hospitalization.


CONCLUSIONS
Type A aortic dissection can develop during TEVAR or even years after TEVAR. Careful operative procedures and follow-up should be mandatory for patients with aortic dissection as TAAD seems to occur more frequently among these patients.
Department of Radiology, Mie University Hospital, Mie, Japan. Electronic address: mar.adriatico0501@gmail.com.
Takatoshi
T
Higashigawa
Department of Radiology, Mie University Hospital, Mie, Japan.
Noriyuki
N
Kato
Department of Radiology, Mie University Hospital, Mie, Japan.
Shuji
S
Chino
Department of Radiology, Mie University Hospital, Mie, Japan.
Takashi
T
Hashimoto
Department of Cardiovascular Surgery, Mie University Hospital, Mie, Japan.
Hideto
H
Shimpo
Department of Cardiovascular Surgery, Ise Red Cross Hospital, Mie, Japan.
Toshiya
T
Tokui
Department of Cardiovascular Surgery, Anjo Kosei Hospital, Anjo, Aichi, Japan.
Toru
T
Mizumoto
Department of Cardiovascular Surgery, Mie Central Medical Center, Tsu, Mie, Japan.
Tomoaki
T
Sato
Department of Cardiovascular Surgery, Kochi Health Sciences Center, Kochi, Japan.
Manabu
M
Okabe
Department of Radiology, Mie University Hospital, Mie, Japan.
Hajime
H
Sakuma
D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D001013:Aorta, Thoracic; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D001018:Aortic Diseases / Q000601:surgery; D001027:Aortography; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D057510:Endovascular Procedures / Q000009:adverse effects; D004937:Esophageal Fistula / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016157:Vascular Fistula / Q000601:surgery