Type IIa endoleak in thoraflex hybrid stent-graft for frozen elephant trunk operation.

A 55-year-old hypertensive woman presented 6 years ago with an uncomplicated Stanford type B acute aortic dissection (SVS/STS acute type B3,10) managed conservatively. Follow-up computed tomography scans showed progressive aneurysmal dilatation of zone 3 (63 mm) and zone 4–10 (47 mm) with retrograde extension into arch (non A–non B extension in Stanford type B, SVS/STS chronic type B2,10) (Figure 1). She underwent a frozen elephant trunk operation with 26/28F, 150 mm hybrid stent graft (Thoraflex THP2628X150B, Vascutek, Inchinnan, Scotland) with an uneventful recovery. Postoperative scan (day 7) confirmed false lumen obliteration around stent-graft, good placement and distal seal of endostent (Figure 1B). She represented 1 month later with breathlessness and anemia (haemoglobin 88 gm%). Computed tomography scan showed large zone 2/3 collection (Figure 1C, 1D) with contrast extravasation between the aortic wall and stent endograft with type IIa endoleak (retroleak from a large 3 intercostal artery) (Figure 2A, 2B). She was managed conservatively and remained stable. Subsequent serial scans showed no extravasation, stable size and thrombosis of the sac.