Double thoracic branch endoprosthesis to repair type IA endoleak after zone 2 thoracic branch endoprosthesis

Thoracic endovascular aortic repair has become the first-line treatment modality for descending thoracic aortic diseases. Coverage of the aortic arch branches is often required to extend the proximal seal zones during thoracic endovascular aortic repair. The thoracic branch endoprosthesis (TBE) is the first US Food and Drug Administration-approved branched device for thoracic endovascular repair allowing for incorporation of the left subclavian artery. Type IA endoleak after zone 2 TBE as well as its rescue options have not been well-described. In this report, we describe two cases of failed zone 2 TBE with a type IA endoleak, rescued with proximal extension zone 0 TBE to create a sandwiched double TBE configuration. Technical considerations as well as the limitations of this technique are discussed.