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Results of celiac trunk stenting during fenestrated or branched aortic endografting
Hélène Wattez1, Teresa Martin-Gonzalez1, Benjamin Lopez2
1Université Lille Nord de France, Lille, France; Aortic Center, Hôpital Cardiologique, Lille, France.
Insights
Median arcuate ligament compression impacts endovascular aortic repair by increasing technical challenges and failed bridging stent implantation in the celiac axis. However, celiac artery bridging stent patency remains good during follow-up.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Anatomy
Background:
- Endovascular aortic repair of visceral segment aneurysms often requires celiac axis (CA) bridging stents.
- Median arcuate ligament (MAL) can compress the CA, causing technical difficulties and potential stenosis.
- This study investigates MAL compression's impact on CA stenting during endovascular aortic repair.
Purpose of the Study:
- To evaluate the influence of MAL compression on technical success rates.
- To assess the patency of CA bridging stents after endovascular repair in patients with and without MAL compression.
Main Methods:
- Retrospective analysis of 113 patients undergoing branched/fenestrated endovascular aortic repair with CA stenting.
- Preoperative CT angiography used to identify MAL compression.
- Follow-up by CT angiography and duplex ultrasound to assess CA bridging stent patency.
Main Results:
- MAL compression was present in 39.8% of patients (MAL+ group).
- The MAL+ group experienced higher rates of complex endovascular techniques (14.2%) and failed bridging stent implantation (6.2%).
- No CA bridging stent thrombosis occurred in the MAL+ group; patency was good during follow-up.
Conclusions:
- MAL compression is linked to increased technical challenges and procedural failures in CA bridging stent placement.
- Despite procedural difficulties, MAL compression does not negatively impact long-term celiac artery bridging stent patency.
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.
