JACC. Case reports · 2026
Endovascular Salvage of Late Type IA Endoleak After Ascending Aortic TEVAR for Ruptured Penetrating Ulcer.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Kaleeny Kyrillos, Kamalanathan Harish, Lewis Jeffrey, Wilson-Smith Ashley, Indraratna Praveen, Akhunji Zakir, Thomas Shannon, Sarathy Kiran, Mathur Gita, Kushwaha Virag
Аннотация
BACKGROUND: Ascending aortic penetrating atherosclerotic ulcers (PAUs) are rare acute aortic syndromes, where guidelines recommend surgical repair. In surgically ineligible patients, endovascular repair has been described; however, data on management of postoperative complications are limited.
CASE SUMMARY: A frail 75-year-old woman presented with dyspnea, 1 month after emergency endovascular repair of a ruptured ascending aortic PAU. Computed tomography aortography (CTA) demonstrated a late type IA endoleak with associated pseudoaneurysm. Given her prohibitive surgical risk, a staged approach was initially used by creating a scaffold with transcatheter aortic valve implantation and deployment of an atrial septal defect occluder across the pseudoaneurysm's neck, followed by patent foramen ovale occluder implantation, coil packing, and thrombin injection. This achieved complete endoleak exclusion and pseudoaneurysm sealing, confirmed on serial CTAs. The patient remains well after 1 year.
DISCUSSION: This is the first case of successful endovascular repair of a type IA endoleak and pseudoaneurysm, following endovascular repair of the ascending aorta.
TAKE-HOME MESSAGE: Complex ascending aortic complications can be managed endovascularly.
CASE SUMMARY: A frail 75-year-old woman presented with dyspnea, 1 month after emergency endovascular repair of a ruptured ascending aortic PAU. Computed tomography aortography (CTA) demonstrated a late type IA endoleak with associated pseudoaneurysm. Given her prohibitive surgical risk, a staged approach was initially used by creating a scaffold with transcatheter aortic valve implantation and deployment of an atrial septal defect occluder across the pseudoaneurysm's neck, followed by patent foramen ovale occluder implantation, coil packing, and thrombin injection. This achieved complete endoleak exclusion and pseudoaneurysm sealing, confirmed on serial CTAs. The patient remains well after 1 year.
DISCUSSION: This is the first case of successful endovascular repair of a type IA endoleak and pseudoaneurysm, following endovascular repair of the ascending aorta.
TAKE-HOME MESSAGE: Complex ascending aortic complications can be managed endovascularly.