Incidence, risk factors, and outcome of retrograde type A aortic dissection after TEVAR

Retrograde type A aortic dissection after thoracic endovascular aortic repair (TEVAR) has recently been recognized as a new pathophysiological entity. Little is known about its incidence, risk factors, and outcome.

Electronic searches were performed in Medline until 8 November 2013. Relevant studies were identified. We looked for consecutive series reporting on incidence, risk factors, and outcome. Registries were excluded. Data were extracted and analyzed according to predefined outcome measures.

Sixteen studies were identified for inclusion for qualitative and quantitative analyses. The incidence of retrograde type A aortic dissection after TEVAR was given in all 16 studies and was between 1.3 and 24 %. Incidence varied substantially with regard to the underlying aortic pathology treated as well as with regard to the application or non-application of supra-aortic transpositions prior to TEVAR. The strong association between acute aortic syndromes and retrograde type A aortic dissection was consistent in all other studies, being highest in the combination of an acute aortic syndrome and supra-aortic rerouting prior to TEVAR (24 %). Both proven and suspected pathophysiological mechanisms causing retrograde type A aortic dissection were consistent in all studies. The time interval between TEVAR and the occurrence of retrograde type A aortic dissection varied between immediate occurrence during the procedure and up to 7 years after treatment. Outcome varied according to the time of occurrence, being best in patients who were treated surgically where the diagnosis was made in hemodynamically stable conditions.

Retrograde type A aortic dissection after TEVAR is not rare in patients with the underlying pathology of type B aortic dissection, type B intramural hematoma as well as after total arch rerouting aimed for zone 0 landing zone deployment. Retrograde type A aortic dissection after TEVAR may occur early or late. Further studies are needed to clarify the pathophysiological mechanisms and to prevent this complication in the future.