Retrograde type A dissection with aortic root rupture is a rare but catastrophic complication of EVAR that can be successfully managed with prompt detection via fluoroscopy and emergent open surgical repair.
Retrograde type A dissection (RTAD) is a rare but catastrophic complication of thoracic endovascular repair. However, only a few cases of RTAD associated with endovascular aortic repair (EVAR) have been reported. Additionally, aortic root rupture has not been reported. An 80-year-old woman presented with a progressively enlarging intrarenal abdominal aortic aneurysm, and she underwent EVAR. However, cardiac tamponade occurred because RTAD occurred at the end of the surgery, and the aortic root ruptured. Therefore, ascending aortic replacement was performed emergently, and the patient was saved. RTAD with EVAR is rare, but it could be a crucial complication. We could rescue the patient by early detection and surgery. Even with EVAR, the possibility of performing an open chest should be considered. Moreover, fluoroscopy could be used immediately if cardiac tamponade is suspected.
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Ishida et al. (2025) studied this question.
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