RepairComplications.PDFVIP

Retrograde Ascending Aortic Dissection During or After Thoracic Aortic Stent Graft Placement Insight From the European Registry on Endovascular Aortic Repair Complications Holger Eggebrecht, MD; Matt Thompson, MD; Herve′Rousseau, MD; Martin Czerny, MD; Lars Lo¨nn, MD; Rajendra H. Mehta, MD, MS; Raimund Erbel, MD; on behalf of the European Registry on Endovascular Aortic Repair Complications Background—Single-center reports have identified retrograde ascending aortic dissection (rAAD) as a potentially lethal complication of thoracic endovascular aortic repair (TEVAR). Methods and Results—Between 1995 and 2008, 28 centers participating in the European Registry on Endovascular Aortic Repair Complications reported a total of 63 rAAD cases (incidence, 1.33%; 95% CI, 0.75 to 2.40). Eighty-one percent Downloaded from of patients underwent TEVAR for acute (n?26, 54%) or chronic type B dissection (n?13, 27%). Stent grafts with proximal bare springs were used in majority of patients (83%). Only 7 (15%) patients had intraoperative rAAD, with the remaining occurring during the index hospitalization (n?10, 21%) and during follow-up (n?31, 64%). Presenting symptoms included acute chest pain (n?16, 33%), syncope (n?12, 25%), and sudden death (n?9, 19%) whereas one fourth of patients were asymptomatic (n?12, 25%). Most patients underwent emergency (n?25) or elective (n?5) / surgical repair. Outcome was fatal in 20 of 48 patients (42%). Causes of rAAD included the stent graft itself (60%), manipulation of guide wires/sheaths (15%), and progression of underlying aortic disease (15%). Conclusions—The incidence of rAAD was low (1.33%) in the present analysis with high mortality (42%). Patients undergoing TEVAR for type B diss