Volume 42, Pages (January 2019)

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Volume 42, Pages 38-42 (January 2019) Successful Management of a Type B Gutter Related Endoleak after Chimney EVAR by Coil Assisted Onyx Embolisation  Marta Ballesteros-Pomar, Gergana T. Taneva, Martin Austermann, Rafael Fernández-Samos, Giovanni Torsello, Konstantinos P. Donas  EJVES Short Reports   Volume 42, Pages 38-42 (January 2019) DOI: 10.1016/j.ejvssr.2018.12.002 Copyright © 2019 The Author(s) Terms and Conditions

Figure 1 Computed tomography angiogram three months after chimney endovascular aneurysm repair demonstrating a persistent type Ia endoleak. EJVES Short Reports  2019 42, 38-42DOI: (10.1016/j.ejvssr.2018.12.002) Copyright © 2019 The Author(s) Terms and Conditions

Figure 2 Sequence of technical steps during the embolization procedure. (A) Advance of the 0.014″ wire in the gutter. (B) Confirmation of the combined type Ia endoleak and type II endoleak via lumbar arteries. (C) Use of coils (Axium) to fill the gap and occlude the type II endoleak. (D) Additional use of Onyx Liquid Embolic System (arrow) for the small gutters and completion angiography showing no evidence of endoleak. EJVES Short Reports  2019 42, 38-42DOI: (10.1016/j.ejvssr.2018.12.002) Copyright © 2019 The Author(s) Terms and Conditions

Figure 3 Computed tomography angiography after coil assisted Onyx embolization showing no evidence of endoleak, in the (A) sagittal and (B) axial projections; arrows point to chimney grafts. EJVES Short Reports  2019 42, 38-42DOI: (10.1016/j.ejvssr.2018.12.002) Copyright © 2019 The Author(s) Terms and Conditions

Figure 4 Magnetic resonance angiography at 10 months demonstrating absence of endoleak. EJVES Short Reports  2019 42, 38-42DOI: (10.1016/j.ejvssr.2018.12.002) Copyright © 2019 The Author(s) Terms and Conditions

Figure 5 Management algorithm for gutter related type Ia endoleaks during chimney endovascular aneurysm repair. EJVES Short Reports  2019 42, 38-42DOI: (10.1016/j.ejvssr.2018.12.002) Copyright © 2019 The Author(s) Terms and Conditions