Strategies for Distal Aortic Reintervention after Repaired Acute Ascending Aortic Dissection

Abstract

Acute type A aortic dissection (TAAAD) is a rare, life threatening emergency. Improvements in surgical management and postoperative blood pressure control have made it clear that the TAAAD is a brief phase in a chronic disease process. Dissection that extends to the distal arch and aorta may cause late complications such as aneurysmal degeneration. The surgeon, therefore, must manage TAAAD with this in mind, and allow extra graft length or debranch the supra-aortic vessels to facilitate late reintervention. This is particularly important in younger patients with distal aortic involvement. Options for late distal reintervention include open surgical replacement of the aorta, aneurysm exclusion with endovascular stent grafts, including the rapidly maturing branched graft technologies, or a combination of the two in a hybrid procedure.

Keywords: Acute type A aortic dissection, Aneurysmal degeneration, Aortic Arch, Branched graft, Debranching, Descending thoracic aorta, Elephant trunk, End-organ ischemia, Endovascular, Reintervention, Repair, Rupture, Stent graft, Supra-aortic vessels, Thoracic aneurysm, Thoracoabdominal aneurysm, Thoraco-abdominal aneurysm, Thoracotomy, Type A, Type B.