Endovascular Management of a Chronic Type A Aortic Dissection: Case Report

Iatrogenic type A aortic dissection following thoracic endovascular aortic repair (TEVAR) is a life-threatening complication, with reported incidence rates ranging from 1.3% to 6.8%. Urgent open surgical repair is recommended when this complication occurs. In the present case, surgery was not performed at the onset of symptoms in a 61-year-old female initially treated with TEVAR for an acute type B aortic dissection. She was referred to our center 3 months later with a chronic type A dissection with the primary entry tear located in the arch. In this very fragile patient, we performed an endovascular repair with an arch branched endograft in combination with surgical debranching of the right carotid and left subclavian arteries. Clinical Impact Branched endograft exclusion of chronic type A dissections resulting from a TEVAR complication is a minimally-invasive approach to consider in very fragile patients to mitigate the potential risks associated with conventional open surgical repair.