Classification System for ChEVAR-Related Endoleaks Proposed by PERICLES Investigators

January 18, 2017—Investigators from the PERICLES registry have proposed a new classification for endoleaks related to chimney graft endovascular aneurysm repair (chEVAR). Konstantinos P. Donas, MD, et al published the editorial in Journal of Endovascular Therapy (JEVT; 2017;24:72–74).

As summarized in the JEVT editorial, the PERICLES registry collected the global transatlantic experience of 13 vascular centers in Europe and the United States, reporting 517 patients with complex aneurysms treated with EVAR and chimney parallel grafts. Systematic scrutiny of the large PERICLES patient cohort enhanced the understanding of gutter-related endoleaks associated with chEVAR. 

In JEVT, the investigators propose a new classification that describes and illustrates three distinct patterns for these phenomena and specific technical modifications for endoleak prevention or treatment:

• Pattern A: Excessive stent graft oversizing (stent graft oversizing by > 30% compared with the diameter of the suprarenal aorta or malapposition to the aortic wall) 
• Pattern B: Insufficient stent graft oversizing (leading to excessive gutter formation that causes endoleaks)
• Pattern C: Inadequate seal zone length (the presence of a short sealing zone in chEVAR can result in early type Ia endoleak or predispose to downward migration of the abdominal device and delayed type Ia endoleak)

Edward Y. Woo, MD, explained the significance of this report in an interview with Endovascular Today. Dr. Woo commented, "Understanding endoleaks is the cornerstone of both treatment and prevention. This classification demonstrates the importance of appropriate planning and sizing during the index procedure. This information may be important for further reducing the rates of gutter leaks during parallel grafting." Dr. Woo is Professor of Surgery at Georgetown University School of Medicine in Washington, DC, and serves as Director of the MedStar Vascular Program and Chairman of the Department of Vascular Surgery.

Drs. Woo and Donas discussed the data from the multicenter European and United States PERICLES registry of snorkel/chimney technique applications in "Lessons From the PERICLES Registry on Complex Aortic Repair" published in September 2015 in Endovascular Today (2015;14:78–81).