Initial Experience with Amplatzer Vascular Plug Embolization for Type Ia Endoleaks Following Thoracic Endovascular Aortic Repair.

BACKGROUND: Type Ia endoleaks (T1aELs) are a common complication after thoracic endovascular aneurysm repair (TEVAR) and remain challenging to manage in patients with aortic dissection. This study presents our initial experience with the Amplatzer vascular plugs (AVPs) for embolization of T1aELs. This study aimed to evaluate the safety and feasibility of AVPs embolization for T1aELs after TEVAR.

METHODS: From January 2020 to May 2025, 12 patients with aortic dissection who developed T1aELs after TEVAR underwent embolization with AVPs. The plugs were deployed adjacent to the endoleak through the false lumen (FL). Follow-up computed tomography angiography (CTA) was performed to evaluate the effectiveness of AVP embolization and the status of the endoleak.

RESULTS: AVPs were successfully deployed in all 12 patients, with subsequent angiography showing no significant blood flow in the FL. The mean FL shrinkage was 40.0 ± 28.6%. The technical success rate was 100%, and the immediate angiographic success rate was 91.7%. During a median follow-up of 16 months (range: 3-48 months), no recurrence of T1aEL was observed in the 11 patients who achieved initial complete occlusion. One patient required staged embolization because of a large, irregular endoleak. No AVP-related complications were observed, including device migration or enlargement of the endoleak.

CONCLUSION: In our experience, AVP embolization is a feasible and potentially effective treatment option for T1aELs following TEVAR, especially for irregular or complex endoleaks. Further large-scale studies are warranted to confirm these findings.