Type IA endoleaks after ch-EVAR · Type IA endoleak in ch-EVAR • Need for detailed description...
Transcript of Type IA endoleaks after ch-EVAR · Type IA endoleak in ch-EVAR • Need for detailed description...
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Type IA endoleaks after ch-EVARAchilles Heel, Damocles sword?
Konstantinos P. Donas, MDVascular Surger Münster, Germany
Head: Univ-Prof. Dr. Giovanni Torsello
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Disclosure
Speaker name:
.................................................................................
I have the following potential conflicts of interest to report:
Consulting
Employment in industry
Stockholder of a healthcare company
Owner of a healthcare company
Other(s)
I do not have any potential conflict of interestX
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Chimney technique
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PERICLES Registry
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PROTAGORAS Study
ENDURANTStent-graft
Advanta/i-Cast V12Chimney graft
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Achilles heel
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Gutter-related type IA endoleak
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Delphi
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GUTTER-RELATED TYPE IA EL
• INCIDENCE
• ETIOLOGY
• THERAPEUTIC MANAGEMENT
• TECHNIQUES TO MINIMIZE THE RISK OF TYPE IA EL NEEDED RE-INTERVENTIONS
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Literature
• No clear description about the time ofoccurence
• Before or after the completion angiographyand use of balloons, cuffs etc?
• New onset of postoperative type IA?
• Associated with increase of aneurysmdiameter or is the AAA diameter stable?
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PERICLES Registry
K. Donas et. al; Ann Surg. 2015 Sep;262(3):546-53
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PERICLES Registry
Intra-op type Ia endoleak: 7.9%
Persistent intra-op type Iaendoleak:
2.9%
Type IA endoleak at latest FU: 5.8%
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BECS (Advanta V12)
3.0-fold increased risk of
developing intraoperative
type I endoleak with
Stainless steel Skeleton +
BECS devices compared to
Nitinol skeleton + BECS
(p=.001).
Scali S, Lee JT, Lachat M, Torsello G, Veith FJ, Donas KP.
Observations from PERICLES Registry, under review
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Nitinol Endoskeleton in triple chimneyswith BECS (Advanta)
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Chimney EVAR Endoleaks
Pattern AExcessive oversizing
of the aortic endograft
Donas KP, Criado FJ, Lachat M, Torsello G, Minion D.
Insights from PERICLES Registry. JEVT 2016 in press
Pattern BUndersized aortic
endograft
Pattern CInsufficient sealing
length and migration
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Pattern A
Infolding of the stent-graft
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Pattern BUndersized aortic endograft
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Onyx and Coil embolization
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Pattern CShort sealing zone
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Type IA endoleak in ch-EVAR
• Need for detailed description about the time of occurence and etiology
• The presented therapeutic algorithm shouldbe evaluated from other centers
PERICLES classification will help to define andtreat better „gutter-relater type I ELs after Ch-EVAR
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Oracle of Delphi
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Type IA endoleaks after ch-EVARAchilles Heel, Damocles sword?
Konstantinos P. Donas, MDVascular Surger Münster, Germany
Head: Univ-Prof. Dr. Giovanni Torsello