Gutters after Chimney EVAR: How „PERICLES and PROTAGORAS“ can protect ACHILLES heel?

One of the main topics at each meeting is the discussion about the importance and clinical relevance of gutter-related endoleaks after ch-EVAR. Herein, we present you an overview of the most important causative mechanisms for the development of persistent gutters and tips to treat and minimize the risk of appearance.


    MD Michel Bosiers
    July 5, 2018

    Thank you Kostas for your excellent presentation.
    if i understand correctly, the use of 3 chimney grafts is associated with a higher risk for type 1a endoleak. Would you suggest to treat patients with ch-EVAR if only 1 or 2 chimney grafts are required?

    Thank you Michel for your comment. The current body of evidence suggests indeed the use of chimney grafts in juxtarenal pathologies with involvement of one or max. 2 target vessels.
    Triple chimneys can have several risks and not only more type IA endoleaks. As we published together, use of bilateral access is associated with significant risk of cardiac and cerebrovascular events for those patients. Additionally, we have a risk of persistent type IA endoleak due to the risk of inadequate oversizing to wrap up around the chimney grafts. This possibility was obvious in the new Classification of gutter-related endoleaks based on the causative mechanisms, published last year in J. Endovascular Therapy.
    In summary, triple chimneys should be considered only in case of anatomical or clinical contraindications for f-EVAR. I hope that soon we will be able to evaluate this cohort of patients from the PERICLES group and provide more scientific impetus for this indication.

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