The surgical management of type IA endoleak after thoracic endovascular aortic repair

OBJECTIVES: Our goal was to investigate the surgical strategy for type Ia endoleak after thoracic endovascular aortic repair (TEVAR) by reporting our experiences. METHODS: From November 2012 to September 2019, a total of 23 patients received surgical management for type Ia endoleak after TEVAR. RESULTS: The operations included total arch replacement with the frozen elephant trunk technique in 15 patients, direct closure of the endoleak in 2 patients, hybrid aortic arch repair in 4 patients, arch debranching with TEVAR in 1 patient and left common carotid artery to left subclavian artery bypass with TEVAR in 1 patient. Among 21 patients with cardiopulmonary bypass (CPB), the mean CPB and aortic cross-clamp times were 146.742.2 and 81.0 +/- 43.3min, respectively. The selective cerebral perfusion time was 18.8 +/- 8.2min in 17 patients with hypothermic circulatory arrest. The in-hospital mortality was 8.7% (2/23). Type Ia endoleak was sealed successfully after surgery in 95.5% (21/22) of patients. The follow-up data were available for all 21 survivors. The median follow-up period was 18months (range 1-84months). During the follow-up period, a total of 8 patients died or had aortic events, including 5 deaths and 6 aortic events. CONCLUSIONS: Different surgical strategies could be selected to treat patients with type Ia endoleak after TEVAR, with acceptable early and late outcomes.