Outcomes of type Ia endoleaks after endovascular repair of the proximal aorta

Objective: Thoracic endovascular aortic repair (TEVAR) can be complicated by a type la endoleak. However, its natural history remains unclear. This report describes the natural history and midterm outcome of conservatively treated type la endoleaks in the proximal aorta. Methods: Between 2007 and 2015, 395 patients underwent TEVAR at our institution. Only TEVARs landing proximally at landing zones 0, 1, and 2 were included (221/395). Type la endoleak's flow was classified as "fast" or "slow" based on the time needed to visualize the aneurysmal sac during arteriogram. Results: The median follow-up was 4.1 years. Aortic dissection, thoracic aortic aneurysm, and traumatic aortic injury were the most common indications for TE-VAR; the incidence of type la endoleak was not statistically different. Forty-seven patients (21.3%) had a type la endoleak. TEVAR landing proximally at zone increased the odds of developing a type la endoleak (odds ratio, 2.8; 95% confidence interval, 1.3-5.9; P = .0072). The 30-day mortality and the overall survival was not influenced by the development of immediate-type la endoleak. In 34 (72.3%) patients, the endoleak resolved spontaneously. Ninety-four percent of these patients had a SlowE (n = 32/34). All of spontaneous resolutions occurred before the end of the first postoperative year. Conclusions: SlowE tends to resolve within 1 year after TEVAR. Initial conservative treatment seems to be a reasonable approach in patients with SlowE.