CTICasesType III Endoleak after Thoracic Endovascular Aortic Repair (TEVAR)
Imaging findings
Non-contrast CT demonstrates a high-attenuation rim around the descending thoracic aorta with a large left pleural effusion of concerning density. Contrast-enhanced CT reveals active contrast extravasation from the junction of overlapping endograft components into the left pleural space, with mass effect on the left atrium and pulmonary vein compression. Aortography confirms the type III endoleak at the component junction, which was treated by placement of a bridging endograft.
Key takeaways
Type III endoleaks in TEVAR arise from structural failures at component junctions or fabric tears in the endograft. Component junction failure is the most common type III endoleak site. Hemorrhage into the pleural space from an aortic endoleak is rare but life-threatening and can occur via direct erosion or tracking through periaortic tissue planes.
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