This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Google Scholar Articles by Eggebrecht, H. PubMed Articles by Eggebrecht, H. Related Collections CV surgery: aortic and vascular disease

(Circulation. 2009;120:S276-S281.)
© 2009 American Heart Association, Inc.

Surgery for Aortic Disease

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; Hervé Rousseau, MD; Martin Czerny, MD; Lars Lönn, MD; Rajendra H. Mehta, MD, MS; Raimund Erbel, MD, on behalf of the European Registry on Endovascular Aortic Repair Complications

From the Department of Cardiology (H.E., R.E.), West-German Heart Center Essen, University of Duisburg-Essen, Essen, Germany; the Department of Vascular Surgery (M.T.), St George’s Vascular Institute, St George’s Hospital NHS Trust, London, United Kingdom; the Department of Radiology (H.R.), Centre Hospitalier Universitaire, Hopital de Rangueil, Toulouse, France; the Department of Cardiothoracic Surgery (M.C.), University of Vienna Medical School, Vienna, Austria; the Department of Interventional Radiology (L.L.), Faculty of Health Sciences, Rigshospitalet University Hospital, University of Copenhagen, Copenhagen, Denmark; and Duke Clinical Research Institute (R.H.M.), Durham, NC.

Correspondence to Holger Eggebrecht, MD, Department of Cardiology, West-German Heart Center, University of Duisburg-Essen, Hufelandstraße 55, 45122 Essen, Germany. E-mail holger.eggebrecht{at}uk-essen.de

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 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 dissection appeared to be most prone for the occurrence of rAAD. This complication occurred not only during the index hospitalization but after discharge up to 1050 days after TEVAR. Importantly, the majority of rAAD cases were associated with the use of proximal bare spring stent grafts with direct evidence of stent graft–induced injury at surgery or necropsy in half of the patients.

---

 

Appendix: EuREC Centers