Annals of Surgery

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

Collapse Box

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.

Login

Article Tools

Share

Article Level Metrics

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.