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Retrograde Aortic Dissection After Thoracic Endovascular Aortic Repair

Canaud, Ludovic MD, PhD; Ozdemir, Baris A. BSc, MRCS; Patterson, Benjamin O. BSc, MRCS; Holt, Peter J. E. PhD, FRCS; Loftus, Ian M. MD, FRCS; Thompson, Matt M. MD, FRCS

Annals of Surgery:
doi: 10.1097/SLA.0000000000000585
Original Articles
Abstract

Objective: To provide data regarding the etiology and timing of retrograde type A aortic dissection (RTAD) after thoracic endovascular aortic repair (TEVAR).

Methods: Details of patients who had RTAD after TEVAR were obtained from the MOTHER Registry supplemented by data from a systematic review of the literature. Univariate analysis and binary logistic regression analysis of patient or technical factors was performed.

Results: In MOTHER, RTAD developed in 16 of the 1010 patients (1.6%). Binary logistic regression demonstrated that an indication of TEVAR for aortic dissection (acute P = 0.000212; chronic P = 0.006) and device oversizing (OR 1.14 per 1% increase in oversizing above 9%, P < 0.0001) were significantly more frequent in patients with RTAD. Data from the systematic review was pooled with MOTHER data and demonstrated that RTAD occurred in 1.7% (168/9894). Most of RTAD occurred in the immediate postoperative (58%) period and was associated with a high mortality rate (33.6%). The odds ratio of RTAD for an acute aortic dissection was 10.0 (CI: 4.7–21.9) and 3.4 (CI: 1.3–8.8) for chronic aortic dissection. The incidence of RTAD was not significantly different for endografts with proximal bare stent (2.8%) or nonbare stent (1.9%) (P = 0.1298).

Conclusions: Although RTAD after TEVAR is an uncommon complication, it has a high mortality rate. RTAD is significantly more frequent in patients treated for acute and chronic type B dissection, and when the endograft is significantly oversized. The proximal endograft configuration was not associated with any difference in the incidence of RTAD.

In Brief

Although retrograde type A aortic dissection (RTAD) after thoracic endovascular aortic repair is an uncommon complication, it has a high mortality rate. RTAD is significantly more frequent in patients treated for acute and chronic type B dissection, and when the endograft is significantly oversized. The proximal endograft configuration was not associated with any difference in the incidence of RTAD.

Author Information

From the Department of Outcomes Research, St George's Vascular Institute, London, United Kingdom.

Reprints: Ludovic Canaud, MD, PhD, St George's Vascular Institute, Room 4.007, St George's Healthcare NHS Trust, Blackshaw Road, London SW17 0QT, UK. E-mail: ludoviccanaud@hotmail.com.

Ludovic Canaud and Baris A. Ozdemir hold joint first authorship/contributorship on this work.

Disclosure: Ludovic Canaud is financially supported by the French Society for Vascular Surgery. The authors declare no conflicts of interest.

© 2014 by Lippincott Williams & Wilkins.