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In the last decade, the chimney EVAR (CHEVAR) has rapidly evolved. It started as a bailout option to save aortic branches in case of inadvertent coverage during EVAR and developed within 10 years of published evidence to a valid endovascular treatment option of complex abdominal aortic pathologies. Recently, the technique was included in the ESVS 2019 guidelines for treatment of abdominal aortic aneurysms (AAA).4 Despite this tremendous evolution from a bailout approach to a therapeutic modality a gutter-related endoleaks remain the Achilles heel of the technique.

How to Deal with the Achilles Heel of the Chimney Endovascular Technique for Complex Aortic Pathologies