Classification of Chimney EVAR-Related Endoleaks: Insights from the PERICLES Registry

Felice Pecoraro, Jason T. Lee, Martin Austermann, Giovanni Torsello, Gaspar Mestres, Theodosios Bisdas, Felice Pecoraro, Konstantinos P. Donas, Frank J. Veith, Mario Lachat, Vincent Riambau, Kenneth Tran, Stefano Fazzini, Sven Seifert, Nilo Mosquera, Suominen Velipekka, Yukun Li, Sonia Ronchey, Nicola Mangialardi, Paolo FrigattiDavid J. Minion, Fabio Pozzi Mucelli, Roberto Adovasio, Ronald Dalman, Daniele Gasparini, Frank J. Criado, Thomas Pfammatter, Juha Salenius, Adam W. Beck, Scott M. Damrauer, Salvatore T. Scali

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Juxtarenal aortic aneurysms (JAAs) pose significant challenges for endovascular aneurysm repair (EVAR). A short or absent infrarenal neck typically excludes standard EVAR as a viable or reasonable treatment option. In this context, the use of chimney grafts (chEVAR) is gaining in popularity and applicability. These grafts are designed to course in the aortic lumen outside the main stent-graft to maintain normal perfusion to the involved target branches. As such, they may represent a promising and less resource-intensive option for management of JAAs. However, this technical strategy is not without challenges of its own, particularly the inevitable creation of “gutters” that result from the interaction of the chimney graft with the main aortic stent-graft. These gutters can become a conduit for type Ia endoleak formation, hence they represent the Achilles’ heel of chEVAR. Current reports point to a relatively wide-ranging incidence (0%–13%) of type Ia endoleaks related to chEVAR. The PERICLES Registry collected the global transatlantic experience of 13 European and US vascular centers reporting 517 patients with complex aneurysms treated with EVAR and chimney parallel grafts. Overall, 6% ofPERICLES chEVAR patients had a type Ia endoleak at completion angiography, but the rate of persistent endoleaks was only 2.9% at a mean 17.1 months of follow-up. Close review of the postoperative computed tomography angiograms of these persistent endoleak patients revealed distinct types and patterns of chEVAR-related type Ia endoleaks and form the basis of a new classification proposedherein. It is hoped that these observations will lead to development of new treatment algorithms for effective management of chimney-related endoleaks and, in some cases, to prevent them from occurring in the first place.
Original languageEnglish
Pages (from-to)72-74
Number of pages3
JournalJournal of Endovascular Therapy
Volume24
Publication statusPublished - 2017

All Science Journal Classification (ASJC) codes

  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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    Pecoraro, F., Lee, J. T., Austermann, M., Torsello, G., Mestres, G., Bisdas, T., Pecoraro, F., Donas, K. P., Veith, F. J., Lachat, M., Riambau, V., Tran, K., Fazzini, S., Seifert, S., Mosquera, N., Velipekka, S., Li, Y., Ronchey, S., Mangialardi, N., ... Scali, S. T. (2017). Classification of Chimney EVAR-Related Endoleaks: Insights from the PERICLES Registry. Journal of Endovascular Therapy, 24, 72-74.