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J Thorac Cardiovasc Surg 2008;135:1387-1388
© 2008 The American Association for Thoracic Surgery

Brief Communication

Surgical intervention for retrograde type A aortic dissection caused by endovascular stent insertion for type B aortic dissection

Vikas Shetty, MD, MRCSa, Hunaid A. Vohra, MD, MRCSa, Nicola Viola, MDa, Ivan Brown, MD, FRCSb, Stephen M. Langley, MD, FRCS (CTh)a,*

a Department of Cardiothoracic Surgery, Wessex Cardiothoracic Centre, Southampton General Hospital, Southampton, United Kingdom
b Department of Cardiothoracic Radiology, Wessex Cardiothoracic Centre, Southampton General Hospital, Southampton, United Kingdom

Received for publication November 21, 2007; accepted for publication November 26, 2007.

* Address for reprints: Stephen M. Langley, MD, Department of Cardiothoracic Surgery Southampton University Hospitals NHS Trust, Southampton General Hospital, Tremona Rd, Southampton, United Kingdom. (Email: stephenlangley@dsl.pipex.com).

The first 20% of the full text of this article appears below.

Retrograde type A aortic dissection after endovascular stent grafting (ESG) for type B aortic dissection is not commonly reported. We report such a complication in a patient 4 weeks after ESG for type B aortic dissection. With the expanding indications for aortic ESGs, knowledge of such a complication and its management is vital because surgeons will face this surgical dilemma more than before.

Clinical Summary

A 63-year-old man presented with chest pain. Chest radiographic analysis showed a widened mediastinum. Computed tomographic aortographic scanning showed type B dissection beginning distal to the left subclavian artery and continuing to the aortic bifurcation. Despite medical management, the patient continued to have chest pain. Two ESGs (Gore TAG; W. L. Gore and Associates, Flagstaff, Ariz) were inserted, extending from the distal arch to the upper descending thoracic aorta. Transesophageal echocardiographic analysis showed a satisfactory result. One day after discharge, the patient was readmitted with further pain. Contrast-enhanced computed tomographic scanning showed type A dissection with an intimal tear adjacent to the proximal ESG. Emergency surgical intervention was performed. The left femoral artery was cannulated after heparinization. . . . [Full Text of this Article]






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