Acute iatrogenic type A aortic dissection following thoracic aortic endografting

Gabriele Piffaretti, Giovanni Mariscalco, Matteo Tozzi, Vito Domenico Bruno, Andrea Sala, Patrizio Castelli

Research output: Contribution to journalArticle (Academic Journal)peer-review

18 Citations (Scopus)

Abstract

Endovascular intervention has emerged as a less traumatic alternative treatment for several diseases of the thoracic aorta.(1,2) However, depending on the different aortic pathologies, procedure related complications have become increasingly evident: severe complications include type I endoleaks, migration, and endograft (EG) collapse, as well as those observed during conventional surgery (eg, stroke and paraplegia).(3,4) One of the emerging and most alarming complication of thoracic endografting is iatrogenic retrograde type A acute dissection (RTAAD).(5) Retrograde type A acute dissection is defined as acute aortic dissection that originates distally to the ascending aorta with a retrograde flap progression into the ascending aorta.(6) This complication has been previously described during conventional cardiac surgery with high mortality rate; previous case reports suggested that the fragility of the aortic wall and Marfan disease were predisposing factors to such a life-threatening complication.(7-9) This report presents a case of iatrogenic RTAAD after EG repair of a descending thoracic penetrating aortic ulcer, requiring emergent surgical replacement of the ascending aorta and the aortic arch. The available English literature on RTAAD was also reviewed, in order to recognize potential predisposing factors and specific strategies to prevent it.

Original languageEnglish
Pages (from-to)993-9
Number of pages7
JournalJournal of Vascular Surgery
Volume51
Issue number4
DOIs
Publication statusPublished - Apr 2010

Keywords

  • Acute Disease
  • Aged
  • Aneurysm, Dissecting
  • Aorta, Thoracic
  • Aortic Aneurysm
  • Aortic Diseases
  • Aortography
  • Blood Vessel Prosthesis Implantation
  • Fatal Outcome
  • Humans
  • Iatrogenic Disease
  • Male
  • Reoperation
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Ulcer
  • Case Reports
  • Journal Article
  • Review

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