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Type a Aortic Dissection Developing during Endovascular Repair of an Acute Type B Dissection

Purpose: To describe an extension of type B dissection into type A during endoluminal treatment of acute type B dissection. Case Report: A 57-year-old man with acute type B dissection underwent endovascular repair using 2 Excluder stent-grafts. Before releasing the second stent-graft, the patient complained of mild central chest pain, headache, and visual flashes, but no hemodynamic changes were noticed. An angiogram, performed soon afterwards, showed a retrograde extension of the dissection through the aortic arch involving both the left carotid artery and the ascending aorta. The procedure was completed, and the patient was transported to the operating room where the proximal ascending aorta was replaced. Spiral computed tomographic angiography performed 2 weeks after the procedure showed complete exclusion of the primary entry tear. At 6-month follow-up, the patient was asymptomatic; the left carotid artery dissection had disappeared. Conclusions: Endovascular repair of acute type B dissection is technically feasible, but longer experience will help prevent technical complications.