Coverage of the celiac artery during TEVAR: is it ever appropriate?

Area of Science:

• Vascular Surgery
• Endovascular Repair
• Aortic Aneurysm Treatment

Background:

• Thoracic endovascular aortic repair (TEVAR) success depends on adequate proximal and distal stent graft sealing.
• Thoracoabdominal aneurysms present challenges due to their extensive nature, often requiring extended landing zones.
• Current strategies for proximal landing zone extension, like subclavian artery coverage, show success, but distal extension outcomes are less studied.

Purpose of the Study:

• To evaluate the safety and implications of extending the distal landing zone in TEVAR by covering the celiac axis.
• To determine the necessity of revascularization procedures when the celiac axis is covered for distal landing zone extension.
• To highlight the importance of patient selection and detailed anatomical assessment for distal landing zone extension in TEVAR.

Main Methods:

• Review of anatomical considerations for distal landing zone extension in TEVAR.
• Analysis of potential outcomes associated with celiac axis coverage.
• Emphasis on angiographic assessment and patient selection criteria.

Main Results:

• Coverage of the celiac axis for distal landing zone extension in TEVAR is perceived as potentially safe due to foregut collateral circulation.
• The long-term outcomes and risks of celiac axis coverage require further investigation.
• Concomitant revascularization may be warranted in select cases based on individual anatomy and risk assessment.

Conclusions:

• Extending the distal landing zone in TEVAR by covering the celiac axis needs careful consideration.
• Thorough pre-procedural evaluation, including detailed angiographic anatomy, is essential for safe and effective TEVAR.
• Individualized patient assessment is critical to decide on the need for revascularization when covering the celiac axis.