Single-stage total endovascular reconstruction for retrograde type A aortic dissection with concomitant abdominal dissecting aortic aneurysm： A Case Report

Background Retrograde type A aortic dissection (rTAAD) is a complex and high-risk condition. Traditional treatment protocols mandate emergency open surgical repair for any dissection involving the ascending aorta (Stanford Type A or DeBakey Type I/II). With ongoing advancements in endovascular devices, simplified and less invasive endovascular treatment options are emerging as viable alternatives for select high-risk patients with ascending aortic involvement, potentially offering advantages over complex total arch replacement strategies. Case presentation This study presents a 73-year-old male patient with retrograde type A aortic dissection presenting with persistent thoracic and back pain for one week. Computed tomography angiography (CTA) and three-dimensional reconstruction revealed a retrograde type A aortic dissection originating from the primary tear at the origin of the left subclavian artery (LSA), extending retrograde to the mid-ascending aorta (segment 0) and antegrade to the iliac bifurcation. The left renal artery originated entirely from the false lumen. The abdominal aortic aneurysm measured 61 mm at its maximum diameter. Following total aortic reconstruction, the patient experienced no complications such as paraplegia or hepatic/renal dysfunction and was discharged one week postoperatively. Three-month follow-up demonstrated favorable remodeling of the ascending aorta. At one-year follow-up, all reconstructed vessels remained patent, and the patient reported no symptoms. Conclusion Final angiography confirmed complete isolation of the false lumen with no internal leakage, validating the effectiveness of fenestration alignment and controlled graft placement. One-year follow-up demonstrated durable aortic remodeling and branch patency comparable to outcomes achieved with hybrid aortic arch repair.