The Particulars: Hybrid repair of aortic arch aneurysms—in which supra-aortic trunks are rerouted and aortic endografts are deployed—has been an appealing option for patients who are not candidates for surgery. The rate of retrograde aortic dissection as a complication of the procedure, however, is not well known.
Data Breakdown: For a study, four of 151 patients (2.6%) who underwent hybrid treatment at one center developed retrograde aortic dissection extending to the ascending aorta perioperatively. Two other patients developed retrograde dissection within 30 days, with another two cases emerged within 2 years. Of the four total perioperative cases in the study, one died within 3 days and the other three underwent emergent ascending aorta and arch open surgical replacement. All three of the latter cases involved medial sternotomy, hypothermic circulatory arrest, and antegrade cerebral perfusion.
Take Home Pearl: Close follow-up following aortic arch endovascular repair appears to be necessary due to the risk of retrograde aortic dissections that can complicate the procedure.