title: Chronic mesenteric ischemia after partial coverage of the celiac artery during TEVAR, case report, and review of the literature.
abstract: BACKGROUND
  Thoracic endovascular aortic repair (TEVAR) has emerged as a safe and effective alternative to open surgery for treatment of thoracic aortic aneurysms. It has recently been reported that stent-graft coverage of the celiac artery (CA) during TEVAR is associated with a low risk of acute mesenteric ischemia. However, the long-term effect of CA coverage on foregut perfusion is unknown. Here, we report the case of a patient who underwent TEVAR with partial coverage of the CA and subsequently developed symptoms of chronic mesenteric ischemia (CMI). She was successfully treated with CA stent placement.
  
  
  METHODS
  Preoperative imaging included computed tomography (CT) angiography of the abdomen and conventional aortogram of a redo-TEVAR, revealing near complete coverage of the CA orifice. Endovascular repair was done using a 7 mm × 20 mm biliary balloon-expandable stent (Cook Medical Inc, Bloomington, IN). A review of the current literature for this rare problem was performed.
  
  
  RESULTS
  Completion arteriography demonstrated successful revascularization of the CA without evidence of endoleak. Postoperatively, the abdominal pain was alleviated with early improved diet tolerance and weight gain. Follow-up CT at 6 month demonstrated widely patent CA. A PubMed review showed no reported cases of CMI secondary to CA coverage during TEVAR in the literature.
  
  
  CONCLUSIONS
  CMI may develop with coverage of the CA during TEVAR. When other causes of abdominal pain and weight loss have been ruled out, revascularization of the CA can help alleviate the symptoms.
authors.affiliation: Division of Vascular and Endovascular Surgery, Thomas Jefferson University Hospital, Philadelphia, PA. Electronic address: michealayad@gmail.com.
authors.forename: Micheal
authors.initials: M
authors.lastname: Ayad
authors.affiliation: Division of Vascular and Endovascular Surgery, Thomas Jefferson University Hospital, Philadelphia, PA.
authors.forename: Zachary J
authors.initials: ZJ
authors.lastname: Senders
authors.affiliation: Division of Vascular and Endovascular Surgery, Thomas Jefferson University Hospital, Philadelphia, PA.
authors.forename: Sean
authors.initials: S
authors.lastname: Ryan
authors.affiliation: Division of Vascular and Endovascular Surgery, Thomas Jefferson University Hospital, Philadelphia, PA.
authors.forename: Babak
authors.initials: B
authors.lastname: Abai
authors.affiliation: Division of Vascular and Endovascular Surgery, Thomas Jefferson University Hospital, Philadelphia, PA.
authors.forename: Paul
authors.initials: P
authors.lastname: DiMuzio
authors.affiliation: Division of Vascular and Endovascular Surgery, Thomas Jefferson University Hospital, Philadelphia, PA.
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Salvatore
mesh_terms: D000800:Angioplasty, Balloon / Q000295:instrumentation; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D002445:Celiac Artery / Q000601:surgery*; D002908:Chronic Disease; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D006801:Humans; D065666:Mesenteric Ischemia / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D008875:Middle Aged; D011474:Prosthesis Design; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome