A after B: Management of Retrograde Dissection complicating thoracic endovascular aortic repair

P0004 

Abstract Submission 

ahmed elsharkawy (1), saidabdelaziz badr (2)

(1) Kasr Alaini Cairo university Hospital, cairo, cairo, (2) DR, CAIRO, CAIRO

ahmed elsharkawy    -  Contact Me
Kasr Alaini Cairo university Hospital

saidabdelaziz badr    -  Contact Me
DR

ahmed elsharkawy    -  Contact Me
Kasr Alaini Cairo university Hospital

Objective: Retrograde type A aortic dissection is a challenging surgical emergency associated with high morbidity and mortality. The aim of this study was to describe our experience with retrograde type A aortic dissection (RAAD) following thoracic endovascular aortic repair (TEVAR) and its surgical management strategy.
Methods: Our study was conducted between January 2011 and January 2021 at Cairo University Hospitals, and included 100 patients undergoing (TEVAR) , of them 8 patients developed retrograde dissection at time interval ranging from 2 weeks to 6 months . The mean age was 55 ± 9 years and 76% of patients were males. All retrograde dissection patients underwent emergency surgical repair under hypothermic circulatory arrest to excise the stent induced new entry and perform hemi arch replacement..
Results: The mean cross clamp time was 93±17 minutes and circulatory arrest time was 25±6 minutes. One patient suffered from acute renal failure requiring hemodialysis during the postoperative hospital stay and one patient developed paraparesis of lower limbs that improved after insertion of spinal drain. In-hospital mortality occurred in one patient(12%) who suffered from fatal hematemesis postoperatively.
Conclusions : Retrograde type A aortic dissection post TEVAR is an uncommon but potentially catastrophic complication of TEVAR. Surgical replacement of ascending aorta and segment of aortic arch involving the entry tear offers an efficient strategy for the management and proved to be safe and durable technique with good early results.

Dissection