Endovascular Repair of Type IA Endoleak With Zone 0 TBE and Carotid-Carotid-Subclavian Bypass.

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.