Intentional coverage of the celiac artery during thoracic endovascular aortic repair

Abstract

Intentional coverage of the celiac artery (CA) can extend the distal landing zone necessary for thoracic endovascular aortic repair. A comprehensive review identified 93 cases in 17 reports describing this technique. The majority (87%) were elective procedures. Prior to endograft deployment, 21 patients underwent CA embolization. Of the remaining, three developed type II endoleaks from the CA requiring treatment. The superior mesenteric artery (SMA) was stented in 18 patients during the operative procedure, with one patient undergoing delayed stent placement. There were five iliac artery injuries but no other intraoperative complications. The 30-day mortality rate was 9.7% with three cases attributed to foregut ischemia. Overall, this procedure is technically safe but is associated with a significant risk of death and morbidity. Furthermore, durability is unclear as long-term data are lacking. Careful patient selection, preoperative determination of adequate CA-SMA collaterals, and demonstration of postprocedure SMA patency are all mandatory components of this procedure. However, the development of foregut ischemia cannot be reliably predicted, and patients should be monitored closely for this unique postoperative complication.

Acute pancreatitis caused by pancreatic ischemia after TEVAR combined with intentional celiac artery coverage and embolization of the branches of the celiac artery

“…Ligation, dissection and embolization of the celiac artery are considered relatively safe because of the communication between the branches of the celiac artery and SMA [6, 7]. Although rare, complications due to reduced blood flow, such as gastric and duodenal ulcers, ischemic cholecystitis, liver dysfunction and splenic necrosis, have been reported [8].…”

Outcomes after celiac artery coverage during thoracic endovascular aortic aneurysm repair

“…4,8 The etiologies for developing complications of SCI during TEVAR are multifactorial and not necessarily related to coverage of the CA but are more likely to the extent of coverage of the thoracic aorta requiring acute coverage of segmental arteries that supply the anterior spinal artery. 11 Our institutional protocol of expectant management resulted in complete recovery of both patients with postoperative SCI.…”

“…2 CA coverage has been demonstrated to be a safe and effective method, but as with other endovascular therapies, the long-term success of this technique is not known. 4 The purpose of this study was to evaluate the outcomes up to 81 months after CA coverage during TEVAR.…”

Two-Stage Hybrid Open and Endovascular with Uncovered Stents Repair of a Crawford Type V Aortic Aneurysm

“…However, only 21 (23%) reported cases underwent this additional procedure. In the remaining 72 patients, three (4%) developed a delayed type II endoleak on CTA evaluation during postoperative follow-up [11].…”