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Peer-reviewedCC BY-NC-ND 4.0JACC Case Reports

Endovascular Salvage of Late Type IA Endoleak After Ascending Aortic TEVAR for Ruptured Penetrating Ulcer

  • Kyrillos Kaleeny1,2
  • Harish Kamalanathan1,2
  • Jeffrey Lewis1,2
  • Ashley Wilson-Smith2
  • Praveen Indraratna1,2
  • Zakir Akhunji3,2
  • Shannon Thomas4,2
  • Kiran Sarathy1,2
  • Gita Mathur1,2
  • Virag Kushwaha1,2
4 affiliations
  1. 1Department of Cardiology, Prince of Wales Hospital, Sydney, Australia
  2. 2University of New South Wales, Kensington, Australia
  3. 3Department of Cardiothoracic Surgery, Prince of Wales Hospital, Sydney, Australia
  4. 4Department of Vascular Surgery, Prince of Wales Hospital, Sydney, Australia
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Abstract

Background: Ascending aortic penetrating atherosclerotic ulcers (PAUs) are rare acute aortic syndromes, where guidelines recommend surgical repair. In surgically ineligible patients, endovascular repair has been described; however, data on management of postoperative complications are limited.

Case Summary: A frail 75-year-old woman presented with dyspnea, 1 month after emergency endovascular repair of a ruptured ascending aortic PAU. Computed tomography aortography (CTA) demonstrated a late type IA endoleak with associated pseudoaneurysm. Given her prohibitive surgical risk, a staged approach was initially used by creating a scaffold with transcatheter aortic valve implantation and deployment of an atrial septal defect occluder across the pseudoaneurysm's neck, followed by patent foramen ovale occluder implantation, coil packing, and thrombin injection. This achieved complete endoleak exclusion and pseudoaneurysm sealing, confirmed on serial CTAs. The patient remains well after 1 year.

Discussion: This is the first case of successful endovascular repair of a type IA endoleak and pseudoaneurysm, following endovascular repair of the ascending aorta.

Take-Home Message: Complex ascending aortic complications can be managed endovascularly.

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Cite

BibTeXRIS
BibTeX
@article{kaleeny2026endovascular,
  title = {{Endovascular Salvage of Late Type IA Endoleak After Ascending Aortic TEVAR for Ruptured Penetrating Ulcer}},
  author = {Kyrillos Kaleeny and Harish Kamalanathan and Jeffrey Lewis and Ashley Wilson-Smith and Praveen Indraratna and Zakir Akhunji and Shannon Thomas and Kiran Sarathy and Gita Mathur and Virag Kushwaha},
  journal = {JACC Case Reports},
  year = {2026},
  month = aug,
  doi = {10.1016/j.jaccas.2026.110003},
  url = {https://doi.org/10.1016/j.jaccas.2026.110003},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Endovascular Salvage of Late Type IA Endoleak After Ascending Aortic TEVAR for Ruptured Penetrating Ulcer
AU  - Kyrillos Kaleeny
AU  - Harish Kamalanathan
AU  - Jeffrey Lewis
AU  - Ashley Wilson-Smith
AU  - Praveen Indraratna
AU  - Zakir Akhunji
AU  - Shannon Thomas
AU  - Kiran Sarathy
AU  - Gita Mathur
AU  - Virag Kushwaha
PY  - 2026
DA  - 2026/08/26
JO  - JACC Case Reports
DO  - 10.1016/j.jaccas.2026.110003
UR  - https://doi.org/10.1016/j.jaccas.2026.110003
AB  - Background: Ascending aortic penetrating atherosclerotic ulcers (PAUs) are rare acute aortic syndromes, where guidelines recommend surgical repair. In surgically ineligible patients, endovascular repair has been described; however, data on management of postoperative complications are limited.  Case Summary: A frail 75-year-old woman presented with dyspnea, 1 month after emergency endovascular repair of a ruptured ascending aortic PAU. Computed tomography aortography (CTA) demonstrated a late type IA endoleak with associated pseudoaneurysm. Given her prohibitive surgical risk, a staged approach was initially used by creating a scaffold with transcatheter aortic valve implantation and deployment of an atrial septal defect occluder across the pseudoaneurysm's neck, followed by patent foramen ovale occluder implantation, coil packing, and thrombin injection. This achieved complete endoleak exclusion and pseudoaneurysm sealing, confirmed on serial CTAs. The patient remains well after 1 year.  Discussion: This is the first case of successful endovascular repair of a type IA endoleak and pseudoaneurysm, following endovascular repair of the ascending aorta.  Take-Home Message: Complex ascending aortic complications can be managed endovascularly.
SN  - 2666-0849
ER  -