Conservative management of delayed retrograde type A aortic dissection after successful hybrid endovascular repair of distal arch aneurysm.

Retrograde Type A aortic dissection following successful endovascular treatment of thoracic aortic disease is not uncommon. We report a case where the primary pathology was distal aortic arch aneurysm without dissection, and the retrograde type A dissection occurred four months after successful hybrid endovascular management with right to left carotid bypass and stent-graft with a Cook Zenith device. As the patient was not medically fit for sternotomy and repair of Type A aortic dissection, progress was monitored with serial CT scans. This case demonstrates that delayed retrograde type A dissection can occur even in cases when there was no previous aortic dissection, and that in selective patients who are poor candidates for major aortic surgery, a conservative approach can be adopted.