title: Results of celiac trunk stenting during fenestrated or branched aortic endografting.
abstract: BACKGROUND
  Endovascular repair of aortic aneurysms involving the visceral segment of the aorta often requires placement of a covered bridging stent in the celiac axis (CA). The median arcuate ligament (MAL) is a fibrous arch that unites the diaphragmatic crura on either side of the aortic hiatus. The ligament may compress and distort the celiac artery and result in difficult cannulation, or stenosis and occlusion of the vessel. This study evaluated the influence of the MAL compression on the technical success and the patency of the celiac artery after branched and fenestrated endovascular aortic repair.
  
  
  METHODS
  We retrospectively analyzed a cohort of consecutive patients treated electively for complex aneurysms with branched and fenestrated endovascular aortic repair between January 2007 and April 2014. All data were collected prospectively. Analysis of preoperative computed tomography angiography on a three-dimensional workstation determined the presence of MAL compression. Patency of the CA bridging stent was assessed during follow-up by computed tomography angiography and duplex ultrasound evaluation. Statistical analysis was performed to compare the outcomes of patients with MAL (MAL+) and without MAL (MAL-) compression.
  
  
  RESULTS
  Of 315 patients treated for aortic disease involving the visceral segment during the study period, 113 had endografts designed with a branch (n = 57) or fenestration (n = 56) for the CA. In 45 patients (39.8%), asymptomatic compression of the CA by the MAL was depicted (MAL+). Complex endovascular techniques were required in this group to access the CA in 16 (14.2%) patients (vs none in the MAL- group; P = .003), which lead to a failed bridging stent implantation in seven patients (6.2%). Increased operative time and dose area product were observed in the MAL+ group, but this did not reach statistical significance. In the MAL+ group, no thrombosis of the CA bridging stents were observed during follow-up; an external compression of the CA bridging stent was depicted in six patients but without hemodynamic effect on duplex ultrasound imaging. In the MAL- group, one CA bridging stent occlusion occurred owing to an embolus from a cardiac source.
  
  
  CONCLUSIONS
  MAL compression is associated with good celiac trunk bridging stent patency during follow-up, but with a higher rate of technical difficulties and failed bridging stent implantation during the procedure.
authors: Université Lille Nord de France, Lille, France; Aortic Center, Hôpital Cardiologique, Lille, France.
authors: Hélène
authors: H
authors: Wattez
authors: Université Lille Nord de France, Lille, France; Aortic Center, Hôpital Cardiologique, Lille, France.
authors: Teresa
authors: T
authors: Martin-Gonzalez
authors: Université Lille Nord de France, Lille, France; Module d'Enseignement et de Recherche Collaboratifs en Statistique (MERCS), Lille, France.
authors: Benjamin
authors: B
authors: Lopez
authors: Université Lille Nord de France, Lille, France; Aortic Center, Hôpital Cardiologique, Lille, France.
authors: Rafaëlle
authors: R
authors: Spear
authors: Université Lille Nord de France, Lille, France; Aortic Center, Hôpital Cardiologique, Lille, France.
authors: Rachel E
authors: RE
authors: Clough
authors: Université Lille Nord de France, Lille, France; Aortic Center, Hôpital Cardiologique, Lille, France.
authors: Adrien
authors: A
authors: Hertault
authors: Université Lille Nord de France, Lille, France; Aortic Center, Hôpital Cardiologique, Lille, France.
authors: Jonathan
authors: J
authors: Sobocinski
authors: Université Lille Nord de France, Lille, France; Aortic Center, Hôpital Cardiologique, Lille, France. Electronic address: stephan.haulon@chru-lille.fr.
authors: Stéphan
authors: S
authors: Haulon
mesh_terms: D000368:Aged; D001014:Aortic Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D002445:Celiac Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D000072226:Computed Tomography Angiography; D003251:Constriction, Pathologic / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D000074742:Median Arcuate Ligament Syndrome; D008875:Middle Aged; D011237:Predictive Value of Tests; D011475:Prosthesis Failure; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency