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Retrograde type A aortic dissection complicating endovascular therapy of type B aortic dissection and descending thoracic aneurysm disease

Zhang, Simeng; Chen, Yanqing; Lu, Qingsheng

doi: 10.1097/HCO.0000000000000567
DISEASES OF THE AORTA, PULMONARY AND PERIPHERAL VESSELS: Edited by Alan C. Braverman

Purpose of review Retrograde type A aortic dissection (RTAD) is a fatal complication after endovascular therapy of type B aortic dissection and descending thoracic aneurysm disease. This review aims to elaborate this lethal complication, the potential risks of its incidence, and feasible approaches to lower the occurrence rate.

Recent findings Many articles have shown lower incidence of RTAD in patients with thoracic aneurysm than those with aortic dissection. Also, acute aortic dissection seems to be more vulnerable when compared with chronic aortic dissection. Recent studies that focused on the risk of RTAD revealed that the mismatch of stent, the weakness of the aortic wall and intraoperative aortic injury played important roles in the development of RTAD. The mismatch of stent includes implanting the stent with the top bare spring, the location of landing zone, the oversizing of the stent on the proximal landing zone, and etc. Some centers presented some measures to lower the risks, such as increasing the oversizing of the stent, avoiding the aortic tortuosity, and locating in the healthy landing zone.

Summary Ongoing research with improved technology and techniques continues to unravel new understanding and preventive measures of RTAD after endovascular treatment of aortic dissection and descending thoracic aneurysm disease. Cardiologists and vascular surgeons should be aware of current evidence and implement guidelines in relation to endovascular therapy of aortic diseases.

Department of Vascular Surgery, Changhai Hospital, The First Affiliated Hospital of the Second Military Medical University, Shanghai, China

Correspondence to Qingsheng Lu, MD, Department of Vascular Surgery, Changhai Hospital, The First Affiliated Hospital of the Second Military Medical University, 168 Changhai Rd., 200433 Shanghai, China. Tel: +86 13 917292504; fax: +86 21 31161662; e-mail: luqs@xueguan.net

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