Annals of vascular surgery
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Review Case Reports
Retrograde type A dissection after endovascular repair of a "zone 0" nondissecting aortic arch aneurysm.
Retrograde type A dissection (RTAD) is not so uncommon after thoracic endovascular aortic repair of type B dissections, especially in the presence of connective tissue disorders. Risk of RTAD after thoracic endovascular aortic repair of nondissecting aneurysms has still to be clarified, mainly if proximal arch involvement requires hybrid repair with ascending aortic side clamping, supra-aortic trunks proximal re-routing and endograft landing in ascending aorta. We report a mid-term RTAD after hybrid repair of a proximal arch nondissecting aneurysm without connective tissue disorders. The technique for ascending aortic replacement without arch endograft removal and literature review about this poorly known complication are presented.
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Despite the publication of recent guidelines for management of the left subclavian artery (LSA) during endovascular stenting procedures of the thoracic aorta, specific management for those presenting with dissection remains unclear. This systematic review attempts to address this issue. ⋯ In patients undergoing endovascular stenting for thoracic aortic dissection, in cases where LSA coverage is necessary, revascularization should be considered before the procedure to avoid complications such as left arm ischemia, stroke, and endoleak, and where feasible, an appropriate preoperative assessment should be carried out.