Skip Navigation LinksHome > August 2014 - Volume 260 - Issue 2 > Retrograde Aortic Dissection After Thoracic Endovascular Aor...
Annals of Surgery:
doi: 10.1097/SLA.0000000000000585
Original Articles

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

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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.

© 2014 by Lippincott Williams & Wilkins.

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