Tailored Revascularization and Endovascular Strategy in the Management of Type 1A Endoleak After Descending Thoracic Aortic Aneurysm (TAA) Repair: A Case Report.

Thoracic endovascular aortic repair (TEVAR) has emerged as the preferred treatment for descending thoracic aortic aneurysms (TAA), but one of its major complications, type 1A endoleaks, can lead to aneurysm rupture and mortality if not managed promptly and effectively. This case report details an 87-year-old male patient who developed a type 1A endoleak following a TEVAR procedure for a large descending TAA. The patient's complex vascular anatomy, including a dominant right vertebral artery and an aneurysmal left subclavian artery, necessitated a tailored surgical approach. A right-to-left carotid bypass via a retroesophageal tunnel and left carotid to left subclavian transposition were performed, followed by TEVAR with balloon-assisted fixation to resolve the endoleak. This case underscores the importance of a strategic, individualized surgical approach in managing post-TEVAR complications, particularly in high-risk patients. This report highlights the effectiveness of hybrid surgical approaches and less invasive interventions, such as balloon-assisted fixation, to optimize patient outcomes while reducing procedural complexity and risk.