{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T22:44:48Z","timestamp":1777848288200,"version":"3.51.4"},"reference-count":6,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,1,3]],"date-time":"2026-01-03T00:00:00Z","timestamp":1767398400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Endovasc Ther"],"abstract":"<jats:sec>\n                    <jats:title>Aim:<\/jats:title>\n                    <jats:p>To present a case in which low-dose 4-dimensional computed tomographic angiography (4D-CTA) enabled precise classification of a type II endoleak following hybrid arch repair for chronic type B aortic dissection, in the setting of inconclusive findings on conventional CTA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case:<\/jats:title>\n                    <jats:p>A 74-year-old woman underwent hybrid arch repair with left common carotid-subclavian bypass and thoracic endovascular aortic repair for chronic type B aortic dissection. Six years postoperatively, aneurysm sac enlargement was noted. Conventional CTA with a 2-phase protocol (early arterial and delayed venous phases) could not distinguish between type Ia and type II endoleaks. Low-dose 4D-CTA (dose-length product: 302.6 mGy\u00b7cm) revealed delayed contrast enhancement within the sac during the late arterial phase, consistent with a type II endoleak originating from the left subclavian artery (LSCA). Targeted coil embolization was successfully performed to resolve the endoleak, and contrast inflow from a branch of the LSCA was confirmed by intraprocedural angiography.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Impact<\/jats:title>\n                    <jats:p>This 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\u00b7cm), substantially lower than the &gt;1000 mGy\u00b7cm reported in prior studies while preserving diagnostic quality. Standardized low-dose 4D-CTA protocols may support broader clinical adoption for endoleak evaluation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15266028251409060","type":"journal-article","created":{"date-parts":[[2026,1,3]],"date-time":"2026-01-03T09:35:02Z","timestamp":1767432902000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Low-Dose 4-Dimensional Computed Tomographic Angiography for Diagnosing Indeterminate Endoleak After Hybrid Arch Repair: A Case Report"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1375-1455","authenticated-orcid":false,"given":"Kenta","family":"Masada","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reiko","family":"Katsuya","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katsukiyo","family":"Kitabayashi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hajime","family":"Ichikawa","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,1,3]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.119.012011"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/15266028221095390"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics13050829"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics15030370"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2022.07.168"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0040-1702144"}],"container-title":["Journal of Endovascular Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15266028251409060","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/15266028251409060","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15266028251409060","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T21:32:10Z","timestamp":1777498330000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/15266028251409060"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,3]]},"references-count":6,"alternative-id":["10.1177\/15266028251409060"],"URL":"https:\/\/doi.org\/10.1177\/15266028251409060","relation":{},"ISSN":["1526-6028","1545-1550"],"issn-type":[{"value":"1526-6028","type":"print"},{"value":"1545-1550","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,3]]},"article-number":"15266028251409060"}}