Bailout Procedure Managing Early Type III Endoleak Post‐TEVAR of Descending Thoracic Aorta With Valiant Stent: A Case Report of Endovascular Approach

Introduction Thoracic aortic aneurysm poses significant diagnostic and surgical challenges. Over time, aneurysms may enlarge, risking rupture or dissection. Thoracic endovascular aortic repair (TEVAR) is a minimally invasive procedure to treat these aneurysms. The thoracic aorta is divided into five landing zones for TEVAR, from the ascending aorta (Zone 0) to the mid‐descending thoracic aorta (Zone 4). Endoleaks, characterized by blood flow outside the stent graft into the aneurysmal sac, can occur post‐TEVAR. Type III endoleaks, involving blood leakage through the graft, are critical and require immediate intervention. Case Presentation A 73‐year‐old man with a history of diabetes, hypertension, and ischemic heart disease presented with severe back pain. Imaging revealed a large, partially thrombosed descending aortic aneurysm. The patient underwent TEVAR, deploying a stent graft in the descending thoracic aorta. Postsurgery, the patient developed severe epigastric pain, and a CTA indicated a Type III endoleak. An urgent reintervention was performed using another stent graft, successfully sealing the endoleak. The patient recovered well postoperation and was discharged with stable vital signs and follow‐up appointments. Discussion Advances in minimally invasive procedures like TEVAR have become the preferred treatment for thoracic aortic aneurysms, especially in elderly patients, due to lower mortality risks. Type III endoleaks, although rare (incidence < 7.5%), remain serious. Early detection through follow‐up imaging, typically CTA, is crucial for timely management. In this case, highlights early detection of the endoleak Type IIIb followed by prompt reintervention with an additional stent‐graft effectively managed the Type IIIb endoleak demonstrating the importance of vigilant post‐TEVAR monitoring. Conclusion Endoleaks are a significant complication of aortic aneurysm repairs. Type III endoleaks following TEVAR, though uncommon, represent a surgical emergency. Early recognition and timely endovascular reintervention are critical to prevent catastrophic outcomes, underscoring the necessity of close post‐TEVAR surveillance.