Outcomes after celiac artery coverage during thoracic endovascular aortic aneurysm repair.
OBJECTIVE
Coverage of celiac artery (CA) during thoracic endovascular aortic aneurysm repair (TEVAR) has been performed to extend the distal seal zone for which preliminary results and short-term follow-up have been reported. We aim to show the outcomes up to 81 months after CA coverage during TEVAR.


METHODS
Patients undergoing TEVAR with coverage of the CA origin from 2005 to 2013 were retrospectively analyzed. Points of analysis include indications for covering the CA, demonstration of collateral circulation between the CA and superior mesenteric artery (SMA), anatomic features of the distal landing zone, rate of reintervention, technical success, presence of clinical ischemic symptoms after the procedure, and mortality.


RESULTS
During the 9-year period, 366 patients underwent TEVAR, 18 (5%) of whom had CA coverage. Eleven (61%) had TEVAR with CA coverage due to a thoracic aneurysm, three (17%) had thoracic aortic dissection related to aneurysm, and four (22%) had previous TEVAR with a type Ib endoleak (EL) requiring distal coverage. Mesenteric angiography in preparation for TEVAR with CA coverage diagnosed a critical SMA stenosis in one patient that was treated with stenting before the index procedure. At the conclusion of the indicated procedure, two patients (11%) had a type Ia EL and two patients (11%) had a type Ib EL. Three of the type I ELs required reintervention. Two patients (11%) had a type II EL, both of which were managed with observation and resolved. Reintervention was required in 27% of patients. Postoperative complications included visceral ischemia in 2 (11%), weight loss in 1 (5%), spinal cord ischemia in 2 (11%), a cerebrovascular event in 1 (6%), and death in 1 (6%). The mean follow-up period was 38 months (range, 0.5-81 months).


CONCLUSIONS
This analysis of outcomes up to 81 months supports the suitability of covering the CA in selected patients for extending the distal landing zone to the visceral aortic level above the SMA or when alternative branch vessel treatment is unavailable. Preoperative angiographic evaluation of the mesenteric collaterals and early postoperative surveillance may limit postoperative complications. Once the CA is covered, new symptoms do not develop unless the SMA is compromised.
Division of Vascular and Endovascular Surgery, University of Alabama at Birmingham, Birmingham, Ala. Electronic address: mkrose@uabmc.edu.
Melanie K
MK
Rose
Division of Vascular and Endovascular Surgery, University of Alabama at Birmingham, Birmingham, Ala.
Benjamin J
BJ
Pearce
Division of Vascular and Endovascular Surgery, University of Alabama at Birmingham, Birmingham, Ala.
Thomas C
TC
Matthews
Division of Vascular and Endovascular Surgery, University of Alabama at Birmingham, Birmingham, Ala.
Mark A
MA
Patterson
Division of Vascular and Endovascular Surgery, University of Alabama at Birmingham, Birmingham, Ala.
Marc A
MA
Passman
Division of Vascular and Endovascular Surgery, University of Alabama at Birmingham, Birmingham, Ala.
William D
WD
Jordan
D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D002445:Celiac Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D003097:Collateral Circulation; D057867:Endoleak / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012039:Regional Blood Flow; D012042:Registries; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome