Simon P Overeem1, Johannes T Boersen2, Richte C L Schuurmann3, Erik Groot Jebbink4, Cornelis H Slump5, Michel M P J Reijnen6, Jean-Paul P M de Vries7. 1. MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands; Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands. Electronic address: s.overeem@antoniusziekenhuis.nl. 2. MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands; Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands; Department of Vascular Surgery, Rijnstate Hospital, Arnhem, The Netherlands. 3. MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands; Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands. 4. MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands; Department of Vascular Surgery, Rijnstate Hospital, Arnhem, The Netherlands. 5. MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands. 6. Department of Vascular Surgery, Rijnstate Hospital, Arnhem, The Netherlands. 7. Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
Abstract
OBJECTIVE: Gutters can be described as the loss of continuous apposition between the main body of the endograft, the chimney stent graft, and the aortic wall. Gutters have been associated with increased risk of type IA endoleaks and are considered to be the Achilles' heel of chimney endovascular aneurysm repair (ch-EVAR). However, there is no classification yet to classify and quantify gutter types after ch-EVAR. METHODS: Different gutter types can be distinguished by their morphologic appearance in two- and three-dimensional views and reconstructed slices perpendicular to the center lumen line. RESULTS: Three main categories are defined by (1) the most proximal beginning of the gutter, (2) the length of gutter alongside the endograft, and (3) its distal end. Type A gutters originate at the proximal fabric of an endograft, type B gutters originate as loss of apposition of the chimney stent graft in the branch vessel, and type C gutters start below the fabric of the endograft. To determine eventual changes of gutter size during follow-up computed tomography angiograms (CTAs), measurements may be performed with dedicated software on the follow-up CTA scan to assess the extent of gutters over the aortic circumference, ranging from 0° to 360° of freedom, together with the maximum gap between the endograft material and the aortic wall as it appears on reconstructed axial CTA scan slices. CONCLUSIONS: The proposed gutter classification enables a uniform nomenclature in the current ch-EVAR literature and a more accurate risk assessment of gutter-associated endoleaks. Moreover, it allows monitoring of eventual progression of gutter size during follow-up.
OBJECTIVE: Gutters can be described as the loss of continuous apposition between the main body of the endograft, the chimney stent graft, and the aortic wall. Gutters have been associated with increased risk of type IA endoleaks and are considered to be the Achilles' heel of chimney endovascular aneurysm repair (ch-EVAR). However, there is no classification yet to classify and quantify gutter types after ch-EVAR. METHODS: Different gutter types can be distinguished by their morphologic appearance in two- and three-dimensional views and reconstructed slices perpendicular to the center lumen line. RESULTS: Three main categories are defined by (1) the most proximal beginning of the gutter, (2) the length of gutter alongside the endograft, and (3) its distal end. Type A gutters originate at the proximal fabric of an endograft, type B gutters originate as loss of apposition of the chimney stent graft in the branch vessel, and type C gutters start below the fabric of the endograft. To determine eventual changes of gutter size during follow-up computed tomography angiograms (CTAs), measurements may be performed with dedicated software on the follow-up CTA scan to assess the extent of gutters over the aortic circumference, ranging from 0° to 360° of freedom, together with the maximum gap between the endograft material and the aortic wall as it appears on reconstructed axial CTA scan slices. CONCLUSIONS: The proposed gutter classification enables a uniform nomenclature in the current ch-EVAR literature and a more accurate risk assessment of gutter-associated endoleaks. Moreover, it allows monitoring of eventual progression of gutter size during follow-up.
Authors: Theodorus G van Schaik; Jorn P Meekel; Vincent Jongkind; Rutger J Lely; Maarten Truijers; Arjan W J Hoksbergen; Willem Wisselink; Jan D Blankensteijn; Kak Khee Yeung Journal: J Endovasc Ther Date: 2018-12-21 Impact factor: 3.487
Authors: Jorn P Meekel; Theodorus G van Schaik; Rutger J Lely; Gerie Groot; Bram B van der Meijs; Willem Wisselink; Jan D Blankensteijn; Kak K Yeung Journal: J Endovasc Ther Date: 2020-04-21 Impact factor: 3.487