Percutaneous transthoracic coil embolization of a gutter-related type Ia endoleak after chimney thoracic endovascular aortic repair.

This report describes the treatment of a gutter-related type Ia endoleak after chimney thoracic endovascular aortic repair to the left subclavian artery. The aneurysm sac was accessed via direct percutaneous transthoracic puncture, followed by selective catheterization of the gutter. Angiography confirmed the endoleak, which was treated with coil embolization. Track embolization was performed using Histoacryl glue. Follow-up computed tomography angiography demonstrated complete resolution of the endoleak. Percutaneous transthoracic coil embolization seems to be a feasible and effective treatment for gutter-related type Ia endoleak after chimney thoracic endovascular aortic repair. Given the anatomical complexity and variation in access options, treatment strategies should be individualized.