Endovascular intervention has emerged as a less traumatic alternative treatment for several diseases of the thoracic aorta.(1,2) However, depending on the different aortic pathologies, procedure related complications have become increasingly evident: severe complications include type I endoleaks, migration, and endograft (EG) collapse, as well as those observed during conventional surgery (eg, stroke and paraplegia).(3,4) One of the emerging and most alarming complication of thoracic endografting is iatrogenic retrograde type A acute dissection (RTAAD).(5) Retrograde type A acute dissection is defined as acute aortic dissection that originates distally to the ascending aorta with a retrograde flap progression into the ascending aorta. This complication has been previously described during conventional cardiac surgery with high mortality rate; previous case reports suggested that the fragility of the aortic wall and Marfan disease were predisposing factors to such a life-threatening complication.(7-9) This report presents a case of iatrogenic RTAAD after EG repair of a descending thoracic penetrating aortic ulcer, requiring emergent surgical replacement of the ascending aorta and the aortic arch. The available English literature on RTAAD was also reviewed, in order to recognize potential predisposing factors and specific strategies to prevent it.

Acute iatrogenic type A aortic dissection following thoracic aortic endografting

PIFFARETTI, GABRIELE;TOZZI, MATTEO;BRUNO, VITO DOMENICO;SALA, ANDREA ANTONIO;CASTELLI, PATRIZIO
2010-01-01

Abstract

Endovascular intervention has emerged as a less traumatic alternative treatment for several diseases of the thoracic aorta.(1,2) However, depending on the different aortic pathologies, procedure related complications have become increasingly evident: severe complications include type I endoleaks, migration, and endograft (EG) collapse, as well as those observed during conventional surgery (eg, stroke and paraplegia).(3,4) One of the emerging and most alarming complication of thoracic endografting is iatrogenic retrograde type A acute dissection (RTAAD).(5) Retrograde type A acute dissection is defined as acute aortic dissection that originates distally to the ascending aorta with a retrograde flap progression into the ascending aorta. This complication has been previously described during conventional cardiac surgery with high mortality rate; previous case reports suggested that the fragility of the aortic wall and Marfan disease were predisposing factors to such a life-threatening complication.(7-9) This report presents a case of iatrogenic RTAAD after EG repair of a descending thoracic penetrating aortic ulcer, requiring emergent surgical replacement of the ascending aorta and the aortic arch. The available English literature on RTAAD was also reviewed, in order to recognize potential predisposing factors and specific strategies to prevent it.
Piffaretti, Gabriele; Mariscalco, G.; Tozzi, Matteo; Bruno, VITO DOMENICO; Sala, ANDREA ANTONIO; Castelli, Patrizio
File in questo prodotto:
File Dimensione Formato  
J_Vascualr_Surgery_2010.pdf

non disponibili

Tipologia: Documento in Post-print
Licenza: DRM non definito
Dimensione 741.36 kB
Formato Adobe PDF
741.36 kB Adobe PDF   Visualizza/Apri   Richiedi una copia
Abstract.docx

non disponibili

Tipologia: Abstract
Licenza: DRM non definito
Dimensione 12.12 kB
Formato Microsoft Word XML
12.12 kB Microsoft Word XML   Visualizza/Apri   Richiedi una copia

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11383/1735403
Citazioni
  • ???jsp.display-item.citation.pmc??? 3
  • Scopus 20
  • ???jsp.display-item.citation.isi??? 18
social impact