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

Felice Pecoraro, Sonia Ronchey, Fabio Pozzi Mucelli, Nicola Mangialardi, Paolo Frigatti, David J. Minion, Roberto Adovasio, Ronald Dalman, Daniele Gasparini, Frank J. Criado, Thomas Pfammatter, Juha Salenius, Adam W. Beck, Scott M. Damrauer, Salvatore T. Scali, Jason T. Lee, Martin Austermann, Giovanni Torsello, Gaspar Mestres, Theodosios Bisdas & 10 others Konstantinos P. Donas, Frank J. Veith, Mario Lachat, Vincent Riambau, Kenneth Tran, Stefano Fazzini, Sven Seifert, Nilo Mosquera, Suominen Velipekka, Yukun Li

Risultato della ricerca: Article

23 Citazioni (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% of PERICLES 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 proposed herein. 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.
Lingua originaleEnglish
pagine (da-a)72-74
Numero di pagine3
RivistaJournal of Endovascular Therapy
Volume24
Stato di pubblicazionePublished - 2017

All Science Journal Classification (ASJC) codes

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

Cita questo

Pecoraro, F., Ronchey, S., Mucelli, F. P., Mangialardi, N., Frigatti, P., Minion, D. J., ... Li, Y. (2017). Classification of Chimney EVAR-Related Endoleaks: Insights from the PERICLES Registry. Journal of Endovascular Therapy, 24, 72-74.

Classification of Chimney EVAR-Related Endoleaks: Insights from the PERICLES Registry. / Pecoraro, Felice; Ronchey, Sonia; Mucelli, Fabio Pozzi; Mangialardi, Nicola; Frigatti, Paolo; Minion, David J.; Adovasio, Roberto; Dalman, Ronald; Gasparini, Daniele; Criado, Frank J.; Pfammatter, Thomas; Salenius, Juha; Beck, Adam W.; Damrauer, Scott M.; Scali, Salvatore T.; Lee, Jason T.; Austermann, Martin; Torsello, Giovanni; Mestres, Gaspar; Bisdas, Theodosios; Donas, Konstantinos P.; Veith, Frank J.; Lachat, Mario; Riambau, Vincent; Tran, Kenneth; Fazzini, Stefano; Seifert, Sven; Mosquera, Nilo; Velipekka, Suominen; Li, Yukun.

In: Journal of Endovascular Therapy, Vol. 24, 2017, pag. 72-74.

Risultato della ricerca: Article

Pecoraro, F, Ronchey, S, Mucelli, FP, Mangialardi, N, Frigatti, P, Minion, DJ, Adovasio, R, Dalman, R, Gasparini, D, Criado, FJ, Pfammatter, T, Salenius, J, Beck, AW, Damrauer, SM, Scali, ST, Lee, JT, Austermann, M, Torsello, G, Mestres, G, Bisdas, T, Donas, KP, Veith, FJ, Lachat, M, Riambau, V, Tran, K, Fazzini, S, Seifert, S, Mosquera, N, Velipekka, S & Li, Y 2017, 'Classification of Chimney EVAR-Related Endoleaks: Insights from the PERICLES Registry', Journal of Endovascular Therapy, vol. 24, pagg. 72-74.
Pecoraro F, Ronchey S, Mucelli FP, Mangialardi N, Frigatti P, Minion DJ e altri. Classification of Chimney EVAR-Related Endoleaks: Insights from the PERICLES Registry. Journal of Endovascular Therapy. 2017;24:72-74.
Pecoraro, Felice ; Ronchey, Sonia ; Mucelli, Fabio Pozzi ; Mangialardi, Nicola ; Frigatti, Paolo ; Minion, David J. ; Adovasio, Roberto ; Dalman, Ronald ; Gasparini, Daniele ; Criado, Frank J. ; Pfammatter, Thomas ; Salenius, Juha ; Beck, Adam W. ; Damrauer, Scott M. ; Scali, Salvatore T. ; Lee, Jason T. ; Austermann, Martin ; Torsello, Giovanni ; Mestres, Gaspar ; Bisdas, Theodosios ; Donas, Konstantinos P. ; Veith, Frank J. ; Lachat, Mario ; Riambau, Vincent ; Tran, Kenneth ; Fazzini, Stefano ; Seifert, Sven ; Mosquera, Nilo ; Velipekka, Suominen ; Li, Yukun. / Classification of Chimney EVAR-Related Endoleaks: Insights from the PERICLES Registry. In: Journal of Endovascular Therapy. 2017 ; Vol. 24. pagg. 72-74.
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title = "Classification of Chimney EVAR-Related Endoleaks: Insights from the PERICLES Registry",
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{\%} of PERICLES 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 proposed herein. 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.",
author = "Felice Pecoraro and Sonia Ronchey and Mucelli, {Fabio Pozzi} and Nicola Mangialardi and Paolo Frigatti and Minion, {David J.} and Roberto Adovasio and Ronald Dalman and Daniele Gasparini and Criado, {Frank J.} and Thomas Pfammatter and Juha Salenius and Beck, {Adam W.} and Damrauer, {Scott M.} and Scali, {Salvatore T.} and Lee, {Jason T.} and Martin Austermann and Giovanni Torsello and Gaspar Mestres and Theodosios Bisdas and Donas, {Konstantinos P.} and Veith, {Frank J.} and Mario Lachat and Vincent Riambau and Kenneth Tran and Stefano Fazzini and Sven Seifert and Nilo Mosquera and Suominen Velipekka and Yukun Li",
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TY - JOUR

T1 - Classification of Chimney EVAR-Related Endoleaks: Insights from the PERICLES Registry

AU - Pecoraro, Felice

AU - Ronchey, Sonia

AU - Mucelli, Fabio Pozzi

AU - Mangialardi, Nicola

AU - Frigatti, Paolo

AU - Minion, David J.

AU - Adovasio, Roberto

AU - Dalman, Ronald

AU - Gasparini, Daniele

AU - Criado, Frank J.

AU - Pfammatter, Thomas

AU - Salenius, Juha

AU - Beck, Adam W.

AU - Damrauer, Scott M.

AU - Scali, Salvatore T.

AU - Lee, Jason T.

AU - Austermann, Martin

AU - Torsello, Giovanni

AU - Mestres, Gaspar

AU - Bisdas, Theodosios

AU - Donas, Konstantinos P.

AU - Veith, Frank J.

AU - Lachat, Mario

AU - Riambau, Vincent

AU - Tran, Kenneth

AU - Fazzini, Stefano

AU - Seifert, Sven

AU - Mosquera, Nilo

AU - Velipekka, Suominen

AU - Li, Yukun

PY - 2017

Y1 - 2017

N2 - 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% of PERICLES 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 proposed herein. 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.

AB - 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% of PERICLES 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 proposed herein. 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.

UR - http://hdl.handle.net/10447/233911

UR - http://journals.sagepub.com/doi/full/10.1177/1526602816678994

M3 - Article

VL - 24

SP - 72

EP - 74

JO - Journal of Endovascular Therapy

JF - Journal of Endovascular Therapy

SN - 1526-6028

ER -