Strategies for Distal Aortic Reintervention after Repaired Acute Ascending Aortic Dissection
Pp. 319-336 (18)
Simon Neequaye and Cherrie Abraham
Acute type A aortic dissection (TAAAD) is a rare, life threatening emergency.
Improvements in surgical management and postoperative blood pressure control have made
it clear that the TAAAD is a brief phase in a chronic disease process. Dissection that
extends to the distal arch and aorta may cause late complications such as aneurysmal
degeneration. The surgeon, therefore, must manage TAAAD with this in mind, and allow
extra graft length or debranch the supra-aortic vessels to facilitate late reintervention. This
is particularly important in younger patients with distal aortic involvement. Options for late
distal reintervention include open surgical replacement of the aorta, aneurysm exclusion
with endovascular stent grafts, including the rapidly maturing branched graft technologies,
or a combination of the two in a hybrid procedure.
Acute type A aortic dissection, Aneurysmal degeneration, Aortic Arch,
Branched graft, Debranching, Descending thoracic aorta, Elephant trunk, End-organ
ischemia, Endovascular, Reintervention, Repair, Rupture, Stent graft, Supra-aortic
vessels, Thoracic aneurysm, Thoracoabdominal aneurysm, Thoraco-abdominal
aneurysm, Thoracotomy, Type A, Type B.
Division of Vascular Surgery, Jewish General Hospital, McGill University, E-110, 3755 Cote-Ste-Catherine, Montreal, Quebec H3T1E2, Canada.