Prognosis of Retrograde Dissection From the Descending to the Ascending Aorta

Abstract

Background-Natural history of aortic dissection (AD) with intimal tear in the descending or abdominal aorta and retrograde extension into the ascending aorta (retrograde AD) remains unknown. The purpose of this study was to elucidate medium-term prognosis of patients with retrograde AD. Methods and Results-Study population consisted of 109 patients with acute type A AD. There were 27 patients (25%) with retrograde AD and 82 patients (75%) with intimal tear in the ascending aorta (antegrade AD). In antegrade AD patients, 60 patients underwent surgery and 22 patients were treated medically. In retrograde AD patients, 14 patients showed localized crescentic high attenuation area along the ascending aortic wall without enhancement in computed tomography. Transesophageal echocardiography revealed complete thrombosis of false lumen (FL) in the ascending aorta (retrograde thrombosed). The remaining 13 patients showed incomplete or no thrombosis (retrograde nonthrombosed). All retrograde nonthrombosed AD patients underwent surgery except for 1 patient with stroke, whereas all retrograde thrombosed AD patients were treated medically. In-hospital mortality rate of retrograde AD patients was significantly lower than that of antegrade AD patients (15% versus 38%, Pϭ0.027). The survival rates in retrograde AD patients were all 85% at 1, 2, and 5 years, which were significantly higher than those of antegrade AD patients (63%, 62%, and 57%, respectively)(Pϭ0.009). Conclusions-Patients

Outcomes of Acute Retrograde Type A Aortic Dissection With an Entry Tear in Descending Aorta

“…Previous studies were mostly conducted on small patient cohorts or mentioned through case reports. 1,11,12 Studies directly comparing the outcomes of initial medical treatment with timely intervention and surgery are even more limited.…”

“…The prevalence of this type of AD is reported to be 7% to 25% of acute type A AD. [1][2][3] Management of this subtype of acute AD, also referred as retrograde type A AD (retro-A AD) or type III-D AD, 4 is controversial, especially when the false lumen (FL) of the ascending aorta is completely thrombosed in patients who are often clinically stable. Although several groups have suggested implementing the standard approaches to treat acute antegrade type A AD in these patients, the distal location of the primary intimal tear in the descending thoracic aorta warrants more extensive aortic replacement with higher surgical risks of mortality or morbidity through a median sternotomy.…”

“…However, the propriety of generalizing their study results, which have been derived from a limited sample size, has been questioned. 1 In this study, we sought to evaluate the long-term outcomes of initial medical therapy in selected patients with acute retro-A AD and compare the outcomes with those who were initially treated by urgent surgery.…”

Clinics in diagnostic imaging (182)

“…Kaji et al describes a 23% mortality rate in Type A dissections originating in the ascending aorta or the aortic arch, compared with a 15% mortality rate for Type A dissections that originated distal to the aortic arch. (13) It has also been proposed that early medical optimisation with controlled use of definitive surgery may be (3) Some authors have suggested that medical therapy may be complimented by early endovascular stenting as an alternative to emergency surgery in selected cases, when there is no evidence of early complication. (14) In summary, the ability to provide early, accurate diagnosis and characterisation for patients with acute aortic dissection is improving, due to earlier access to advanced imaging while patients are still within the emergency department.…”

Acute Retrograde Ascending Aortic Dissection During Thoracic Endovascular Aortic Repair in a Rare Triple-Barreled Aortic Dissection

“…RAAD is a potentially lethal complication of thoracic endovascular aortic repair (TEVAR). 1 There are several potential mechanisms of RAAD in patients undergoing TEVAR. The majority were related to the trauma caused by the semi-rigid stent graft either during implantation or subsequently after implantation caused by repeated subtle…”