Intraoperative Gutter Leaks That Merit Our Attention

Area of Science:

• Vascular Surgery
• Endovascular Repair
• Aortic Aneurysm Management

Background:

• Gutter endoleaks following endovascular aneurysm repair (EVAR) are a concern.
• The natural history and morbidity associated with gutter endoleaks remain unclear.
• Strategies for managing intraoperative gutter endoleaks require further definition.

Purpose of the Study:

• To evaluate the outcomes of intraoperative gutter endoleaks.
• To identify strategies for managing these endoleaks.
• To determine predictors of postoperative endoleaks.

Main Methods:

• Retrospective review of patients undergoing parallel stent graft repair (2010-2015).
• Analysis of intraoperative and postoperative imaging, and interventions.
• Classification of gutter leaks into low-flow/nonsac-enhancing and high-flow/sac-enhancing types.

Main Results:

• 36% of patients had intraoperative gutter endoleaks.
• 17 patients underwent adjunctive procedures in the operating room.
• Low-flow/nonsac-enhancing endoleaks showed a 73% spontaneous resolution rate by 30 days.
• Leaving the operating room with an endoleak was the only significant predictor of postoperative endoleaks.

Conclusions:

• Intraoperative management of gutter endoleaks is effective.
• High-flow endoleaks can be converted to low-flow endoleaks.
• Low-flow/nonsac-enhancing gutter endoleaks typically resolve spontaneously.
• Intraoperative gutter endoleaks do not predict future aneurysm sac growth.