Thoracic endovascular aortic repair for retrograde type A aortic dissection with an entry tear in the descending aorta.

PURPOSE: To report the immediate and follow-up outcome of thoracic endovascular aortic repair (TEVAR) in highly selected patients with retrograde type A aortic dissection (RAAD) and an entry tear in the descending aorta.

MATERIALS AND METHODS: TEVAR was performed in 17 patients with RAAD and an entry tear in the descending aorta. None of the patients had severe aortic regurgitation, cardiac tamponade, coronary artery involvement, or brain ischemia. The false lumen in the ascending aorta was patent in nine patients. Two patients had acute malperfusion of the branched artery. Computed tomography (CT) was performed 14 days, 3 months, and 6 months after the intervention and annually thereafter.

RESULTS: All procedures were technically successful, with complete coverage of the entry tear and complete thrombosis of the false lumen in the ascending aorta. All patients survived through the follow-up period (25.7 months ± 17.2). TEVAR resulted in thrombosis of the false lumen, reabsorption of the false lumen thrombus, and enlargement of the true lumen. The mean maximal diameter of the ascending aorta and the false lumen in the ascending aorta significantly decreased after TEVAR. At the distal edge of the stent graft, the mean diameter of the descending aorta and the false lumen markedly decreased after TEVAR. Complete thrombosis of the false lumen was observed at the distal edge of the stent graft in 16 (94.1%) patients and at the diaphragmatic level in 9 (52.9%) patients.

CONCLUSIONS: TEVAR for RAAD with an entry tear in the descending aorta is a safe and effective technique in highly selected patients.