Surgery for retrograde dissection and endoleak repair following endovascular repair of type B aortic dissection.

This video tutorial presents a case of repair of a delayed-onset retrograde type A dissection after TEVAR with a left carotid-subclavian bypass for acute type B dissection. One of our key challenges was problematic brain and spinal cord protection in a frail patient with distal dissection, and dissection involving an ectasic brachiocephalic trunk extending into the right carotid artery with a significantly increased risk of stroke and paraplegia.  We demonstrate the repair of the dissection using the frozen elephant trunk technique and we also present sequential brain and visceral perfusion diagrams.