Retrograde type A dissection in the Vascular Quality Initiative thoracic endovascular aortic repair for dissection postapproval project

• Published in: Journal of vascular surgery 2022-05, Vol.75 (5), p.1539-1551
• Main Authors: Beck, Adam W., Wang, Grace, Lombardi, Joseph V., White, Rodney, Fillinger, Mark F., Kern, John A., Cronenwett, Jack L., Cambria, Richard P., Azizzadeh, Ali
• Format: Article
• Language: English
• Subjects: Aneurysm, Dissecting - diagnostic imaging; Aneurysm, Dissecting - etiology; Aneurysm, Dissecting - surgery; Aortic; Aortic Aneurysm, Thoracic - diagnostic imaging; Aortic Aneurysm, Thoracic - etiology; Aortic Aneurysm, Thoracic - surgery; Blood Vessel Prosthesis - adverse effects; Blood Vessel Prosthesis Implantation; Dissection; Endovascular; Endovascular Procedures; Female; Humans; Male; Retrograde; Retrospective Studies; Stents - adverse effects; TEVAR; Thoracic; Treatment Outcome
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2021.11.075

Retrograde dissection (RD) can be a serious complication after thoracic endovascular aortic repair (TEVAR), with retrograde type A dissection (RTAD) particularly life-threatening. Prior studies have suggested that treatment timing, anatomic characteristics, device selection, and procedural conduct of TEVAR performed for type B aortic dissection could mitigate the occurrence of RD. The Vascular Quality Initiative TEVAR for Dissection Registry is an ongoing project meant to satisfy Food and Drug Administration requirements for postmarket approval surveillance of the Gore conformable TAG thoracic endoprosthesis (W.L. Gore & Associates, Flagstaff, Ariz), Medtronic Valiant thoracic stent graft (Medtronic, Santa Rosa, Calif), and Cook Medical dissection devices (Cook Medical, Bloomington, Ind) and provides a unique source of evaluation for RTAD in a prospectively collected real-world registry. A total of 588 consecutive patients at 49 institutions had undergone TEVAR for acute (1 year. A total of 19 patients with RD (3.2%) were identified, 9 of whom had been treated for acute and 10 for chronic dissection, a 2.7% and 4.0% incidence, respectively (P = .48, acute vs chronic). Of the 19 RD cases, 15 were RTAD, 6 after treatment of acute and 9 after treatment of chronic dissection, a 1.8% and 3.6% incidence, respectively (P = .19, acute vs chronic). Five cases of RD had occurred intraoperatively (four of which were RTAD). The median time to RD and RTAD was 62 and 69 days, respectively (range, 0 to 1600 days). Of the 15 patients with RTAD, 12 had undergone surgical repair and 2 had not undergone repair; the treatment of one was unknown. The overall mortality was 33.3% (5 of 15). The factors associated with RTAD included more extensive dissection (mean, 5.6 zones without RTAD vs 8.5 zones with RTAD; P = .001), female sex (28.3% female without RTAD vs 53.3% with RTAD; P = .04), and non-White race (62.7% White without RTAD vs 33.