2022 Volume 31 Issue 2 Pages 51-56
RTAD (retrograde type A aortic dissection) associated with stent-graft insertion is a condition in which intimal tear occurs due to a stent-graft inserted into the aortic arch and the descending aorta, and new dissection extends retrogradely to the ascending aorta. While the indications for TEVAR are expanding, the frequency of occurrence is as low as 1–2%, but the mortality rate is as high as 30–40%, RTAD has become an important problem. Risk factors for its occurrence include the presence of a bare stent on the proximal side of the stent-graft, oversize, touch-up balloon dilation, the bird beak phenomenon on the lesser curvature side, and zone 2 or more proximal placement. Treatment of RTAD requires replacement of the ascending aorta and aortic arch using the indwelling stent-graft as a frozen elephant trunk. In TEVAR, it is important to familiarize yourself with the characteristics of various devices, become familiar with the appropriate placement method, and continue long-term follow-up to improve treatment results.
