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Published on: March 28, 2025
Endovascular Repair of Type IA Endoleak With Zone 0 TBE and Carotid-Carotid-Subclavian Bypass
Anmol K Multani1, Patrick R Vargo2, Francisco B Alexandrino1
1Department of Cardiology, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Background:
Type IA endoleaks are a serious complication of thoracic endovascular aortic repair. Consensus is limited on a superior management strategy.
Case Summary:
A 76-year-old man with thoracic endovascular aortic repair presented with dyspnea. Imaging revealed a thoracic aortic aneurysm with type IA endoleak compressing adjacent structures. He declined open arch repair and underwent right carotid-left carotid-left subclavian bypass and aortic arch zone 0 thoracic branch endoprosthesis (TBE) placement. The endoleak was eliminated, symptoms resolved, and imaging confirmed graft patency.
Discussion:
Type IA endoleaks pose high rupture risk, and zone 0 repair is challenging because cerebral and upper extremity perfusion must be preserved. Evidence for TBE use in zone 0 is sparse. Our case showed successful endovascular carotid-carotid-subclavian bypass with zone 0 TBE placement.
Take-Home Message:
Endovascular repair with zone 0 TBE and carotid-carotid-subclavian bypass is a feasible option for type IA endoleak repair.
