Page 24 - Virtual Vascular Volume 7
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Retrograde Type A Dissection
This 54-year old man had a chronic type B dissecting aneurysm from expansion of the true lumen. RETROGRADE TYPE A DISSECTION is a very rare, but dreaded complication of thoracic endograft-
He was treated with a custom made TEVAR with a single fenestration/stent to preserve the left ing (TEVAR). The risk is higher for patients who had previous aortic dissections and weak, dilated
subclavian artery. The false lumen was successfully excluded. aortic landing zone. The exact cause is unknown but believed to be due to hemodynamic stress at
the proximal landing zone induced by a change of compliance, oversizing, undue movement of the
Soon after TEVAR he complained of chest pain and an urgent CT scan confirmed that he had stent graft, and proximal exposed bare metal stents and barbs.
sustained a retrograde TYPE A DISSECTION. An urgent open repair of the ascending aorta was
required to salvage this complication. Unfortunately subsequent to this operation he also devel- Note the newly formed dissection flap extending into the coronary sinus, and the dilated ascend-
oped delayed PARAPLEGIA, likely a result of long thoracic aortic coverage and hypotension, lead- ing aorta.
ing to spinal cord ischemia.
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