Descending Thoracic Aortic Aneurysm with Vertebral Erosion Due to Type IA Endoleak after TEVAR

Abstract

A 71-year-old man was found to have a saccular aneurysm of descending aorta with a concomitant vertebral erosion near the aneurysm. The aneurysmal diameter expanded from 40 mm to 43 mm during eight months, and we treated the aneurysm with TEVAR. Two thoracic endovascular grafts were released from the left subclavian artery (zone 3) to the T8 level. However, postoperative CT revealed an endoleak. We observed the patient carefully because the type of the endoleak was unknown at first. But the aneurysmal lesion occurred a residual expansion with the progression of the vertebral erosion. Accordingly, the patient complained of back pain. Thus, we reviewed CT images for an additional treatment, and pointed out a bird-beak configuration at the proximal edge of stent graft. Therefore, we concluded that a type Ia endoleak occurred after TEVAR and it caused the progressive expansion of the aneurysmal lesion. As the additional treatment, we extended the proximal edge of stent graft to zone1 by two debranching TEVAR combined with an axillary-axillary-left common carotid artery bypass. The endoleak and the progression of the vertebral erosion were terminated after the additional treatment. Also, the back pain disappeared immediately after the treatment. The CT at two years after the additional treatment showed shrinkage of the aneurysm.