Low-Dose 4-Dimensional Computed Tomographic Angiography for Diagnosing Indeterminate Endoleak After Hybrid Arch Repair: A Case Report

Low-dose 4D-CTA allowed for precise classification of the endoleak and guided appropriate reintervention. This modality represents a useful and practical tool for endoleak evaluation, especially when standard imaging is inconclusive.Clinical ImpactThis case highlights the diagnostic value of 4-dimensional computed tomographic angiography (4D-CTA) in classifying endoleaks after thoracic endovascular aortic repair (TEVAR), particularly when standard CTA is inconclusive. The 4D-CTA identified a type II endoleak from the left subclavian artery, enabling definitive diagnosis and targeted coil embolization. Notably, the scan was performed using a low-dose protocol (dose-length product: 302.6 mGy·cm), substantially lower than the >1000 mGy·cm reported in prior studies while preserving diagnostic quality. Standardized low-dose 4D-CTA protocols may support broader clinical adoption for endoleak evaluation.