Document Detail

Retrograde type A aortic dissection after endovascular stent graft placement for treatment of type B dissection.
MedLine Citation:
PMID:  19171859     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Retrograde type A aortic dissection has been deemed a rare complication after endovascular stent graft placement for type B dissection. However, this life-threatening event appears to be underrecognized and is worth being investigated further. METHODS AND RESULTS: Eleven of 443 patients developed retrograde type A aortic dissection during or after stent grafting for type B dissection from August 2000 to June 2007. Of these 11 patients, 3 had Marfan syndrome. The Kaplan-Meier estimate of the rate of freedom from this event at 36 months is 97.4% (95% confidence interval, 0.95 to 0.99). The new entry was located at the tip of the proximal bare spring of the stent graft in 9 patients, was within the anchoring area of the proximal bare spring in 1, and remained unknown in 1 patient. Eight patients were converted to open surgery, and 2 received medical treatment. One patient suddenly died 2 hours after the primary stent grafting, and 2 died within 1 week after the surgical conversion, so mortality reached 27.3%. During the follow-up from 3 to 50 months, type I endoleak was identified in 1 patient 3 months after the surgical exploration and disappeared at 6 months. CONCLUSIONS: Retrograde type A aortic dissection after stent grafting for type B dissection appears not to be rare and results from mixed causes. Fragility of the aortic wall and disease progression may predispose to it, whereas stent grafting-related factors make important and provocative contributions. Avoiding aortic arch stent grafting in Marfan patients, preferably selecting the endograft without the proximal bare spring for patients with a kinked aortic arch or with Marfan syndrome (if endografting is used), improving the device design, and standardizing endovascular manipulation might lessen its occurrence.
Zhi Hui Dong; Wei Guo Fu; Yu Qi Wang; Da Qiao Guo; Xin Xu; Yuan Ji; Bin Chen; Jun Hao Jiang; Jue Yang; Zhen Yu Shi; Ting Zhu; Yun Shi
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Publication Detail:
Type:  Journal Article     Date:  2009-01-26
Journal Detail:
Title:  Circulation     Volume:  119     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2009 Feb 
Date Detail:
Created Date:  2009-02-10     Completed Date:  2009-03-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  735-41     Citation Subset:  AIM; IM    
Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
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MeSH Terms
Aneurysm, Dissecting / etiology*,  radiography,  surgery*
Aorta, Thoracic / surgery
Aortic Aneurysm, Thoracic / etiology*,  radiography,  surgery*
Blood Vessel Prosthesis Implantation / adverse effects*
Follow-Up Studies
Kaplan-Meiers Estimate
Marfan Syndrome / complications
Middle Aged
Postoperative Complications
Stents / adverse effects*
Tomography, X-Ray Computed

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