Retrograde type A aortic dissection is a notable complication of endovascular stent grafting for type B dissection, and risk may be mitigated by avoiding arch stenting in Marfan patients and optimizing device selection.
Retrograde type A aortic dissection after stent grafting for type B dissection appears not to be rare and results from mixed causes. Fragility of the aortic wall and disease progression may predispose to it, whereas stent grafting-related factors make important and provocative contributions. Avoiding aortic arch stent grafting in Marfan patients, preferably selecting the endograft without the proximal bare spring for patients with a kinked aortic arch or with Marfan syndrome (if endografting is used), improving the device design, and standardizing endovascular manipulation might lessen its occurrence.
Dong et al. (Tue,) studied this question.