Thoracic endovascular aneurysm repair has been well described in the literature as a treatment for a wide range of thoracic aortic pathologies. As with any intervention, there remains a risk of an unfavorable outcome, including endoleak, a term used to describe unexpected blood flow between the stent-graft and the wall of the excluded aneurysm. Endoleaks cause pressurized enlargement of the aneurysmal sac and may lead to catastrophic outcomes such as rupture and death. Type 1b endoleak represents a distal landing zone that is compromised by retrograde blood flow. Moreover, there is a lack of data on type 1b endoleaks and its management options. With the increase in emerging endovascular techniques and technologies, endoleaks are more frequent. However, the management of endoleaks is not standardized among different centers. The purpose of this article is to provide an overview of type 1b endoleaks after thoracic endovascular aneurysm repair, current management options, and our experience.

Surgical aortic repair has progressed from aneurysm ligation to homografts to Dacron grafts to totally endovascular interventions. These fields will continue to evolve, and new endovascular technology will be used in virtually every part of the aorta, eventually dominating this field of surgery. However, as surgeons, we must be cautious and not let go of our open-surgery skills, as they will always be the ultimate bailout solution.