Expert opinion: How to treat type IA endoleakage

Abstract

Type Ia endoleaks due to failed sealing or loss of landing zone and the adequate management thereof remain crucial for long-term therapeutic success following TEVAR. This expert opinion summarizes our institutional experience with endovascular, open surgical, and hybrid techniques in the context of recent scientific publications. The rapid turnover of technical innovations, but most importantly outcome data demonstrate the requirement for increasingly patient-tailored treatment strategies and the need for specialized aortic centers. The latter should offer a complete range of treatment options, an adequate perioperative management, and the highest level of multidisciplinary expertise.

“Loss of landing zone”—Stabilizing endovascular treatment solutions in the aortic arch after thoracic endovascular aortic repair

“…This can lead to a kink in the FET and cause the FET prosthesis to ride on the proximal springs of the stent, which can lead to fabric damage and, subsequently, penetration of the FET and cause a type III endoleak over time ( Fig 2 , B ). Second, the higher restoring forces and powerful anchoring of the FET in the TEVAR, compared with that in the native aorta, in combination with aortic movement could cause flattening of the prosthesis if the FET is incidentally pulled forward for the proximal anastomosis and again predispose to damaging the prothesis and the formation of a type II endoleak 8 ( Fig 2 , C and D ).…”