Conservative Management of Delayed Retrograde Type A Aortic Dissection after Successful Hybrid Endovascular Repair of Distal Arch Aneurysm

Abstract

Retrograde Type A aortic dissection following successful endovascular treatment of thoracic aortic disease is not uncommon. We report a case where the primary pathology was distal aortic arch aneurysm without dissection, and the retrograde type A dissection occurred four months after successful hybrid endovascular management with right to left carotid bypass and stent-graft with a Cook Zenith device. As the patient was not medically fit for sternotomy and repair of Type A aortic dissection, progress was monitored with serial CT scans. This case demonstrates that delayed retrograde type A dissection can occur even in cases when there was no previous aortic dissection, and that in selective patients who are poor candidates for major aortic surgery, a conservative approach can be adopted.

Key Words:

• Hybrid
• extra-anatomical bypass
• stent-graft
• aortic arch
• intramural haematoma
• aortic dissection.

Additional information

Notes on contributors

Y.C. Chan

Dr. Y. C. Chan, M.B., B.S., B.Sc., M.D., F.R.C.S., F.R.C.S. (General Surgery), F.C.S.H.K. Division of Vascular & Endovascular Surgery Department of Surgery University of Hong Kong Medical Centre South Wing, 14^th Floor K Block Queen Mary Hospital Pokfulam Road Hong Kong Tel.: [phone] Fax: [phone] E-mail: [email protected]