• Iván Alejandro De León Ayala, Yu-Ting Cheng, Shao-Wei Chen, Sung-Yu Chu, Yu-Yun Nan, and Kuo-Sheng Liu.
• Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan.
• J. Thorac. Cardiovasc. Surg. 2022 Jun 1; 163 (6): 2012-2021.e6.

ObjectiveThoracic endovascular aortic repair (TEVAR) can be complicated by a type Ia endoleak. However, its natural history remains unclear. This report describes the natural history and midterm outcome of conservatively treated type Ia endoleaks in the proximal aorta.MethodsBetween 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 Ia endoleak's flow was classified as "fast" or "slow" based on the time needed to visualize the aneurysmal sac during arteriogram.ResultsThe median follow-up was 4.1 years. Aortic dissection, thoracic aortic aneurysm, and traumatic aortic injury were the most common indications for TEVAR; the incidence of type Ia endoleak was not statistically different. Forty-seven patients (21.3%) had a type Ia endoleak. TEVAR landing proximally at zone 1 increased the odds of developing a type Ia 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 Ia 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.ConclusionsSlowE tends to resolve within 1 year after TEVAR. Initial conservative treatment seems to be a reasonable approach in patients with SlowE.Copyright © 2020 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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