Management Of Type 1a Endoleak After Tevar
Paul Hanna, DO.
Newark Beth Israel Medical Center, Jersey City, NJ, USA.
OBJECTIVES: To review the management of Type B aortic dissections as well as present an innovative, multi-specialty approach to management of a common complication after endovascular repair.
METHODS: 58yo M who presented to the emergency department (ED) with acute onset back and chest pain. She was found on imaging to have a Type B Aortic Dissection (TBAD) from Zone 3 to Zone 7 (SVS classification Type B3,7) with associated left sided hemothorax. The patient was taken for a TEVAR with insertion of a Cook Zenith Alpha endograft proximally as well as a Cook Distal Bare-Metal Dissection Stent graft (PETTICOAT - Provisional ExTension To Induce COmplete ATtachment). The patient did well and was discharged to home the perioperative recovery period. The patient returned to the ED 6 months later with recurrent pain and was found on imaging to have a Type 1a endoleak with migration of the stent graft and aneurysmal degeneration. The patient was successfully managed with sternotomy and aortic arch debranching, TEVAR and coil embolization of the left subclavian artery. RESULTS: The patient was seen on multiple postop visits. Repeat imaging shows adequate treatment with thrombosis of the false lumen and expansion of the true lumen.
CONCLUSIONS: Type 1A endoleak after a TEVAR, in our experience, was best treated with a hybrid approach in conjunction with our cardiothoracic surgeons. After a debranching to zone 0 was performed, adequate deployment of an endovascular stent was possible with a favorable outcome at 1 year.
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