• Li Ma, Long Liu, Sheng Yan, and Jun Yan.
• Department of Anesthesiology, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China.
• Medicine (Baltimore). 2022 Aug 5; 101 (31): e29615e29615.

RationaleThe management of retrograde type A dissection (RTAD) after thoracic endovascular aortic repair (TEVAR) for type A aortic dissection (TAAD) has rarely been reported. We report the management of RTAD after TEVAR with in situ fenestration for TAAD.Patient ConcernsA 59-year-old man with TAAD had undergone TEVAR with in situ fenestration 4 months prior to presenting to our emergency room complaining of acute chest and back pain. Computed tomography angiography showed RTAD starting from the proximal endograft and extending to the aortic root.DiagnosisThe patient was diagnosed with RTAD.InterventionsWe performed only the Bentall procedure, and the patient did not require total arch replacement. We removed the bare spring of the proximal endograft and anastomosed the prosthetic graft with the endograft and the native ascending aortic wall.OutcomesThe postoperative course was uneventful, and the patient remained asymptomatic for 3 years after surgery. Computed tomography angiography at the 3-year follow-up showed no perivalvular or anastomotic leakage.LessonsRTAD after TEVAR for TAAD was safely and effectively treated by anastomosing the prosthetic graft with the endograft and the native ascending aortic wall instead of total arch replacement.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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