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Early and midterm outcomes of celiac artery coverage during thoracic endovascular aortic repair
Hiroshi Banno1, Shuta Ikeda1, Yohei Kawai1
1Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Insights
Planned celiac artery (CA) coverage during thoracic endovascular aortic repair (TEVAR) is a safe and effective method for achieving adequate distal sealing in select patients. Long-term outcomes require further investigation in larger prospective studies.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Aortic Disease Management
Background:
- Thoracic endovascular aortic repair (TEVAR) sometimes necessitates celiac artery (CA) coverage for optimal distal seal.
- This study evaluates the outcomes of planned CA coverage in TEVAR procedures.
Purpose of the Study:
- To assess the safety and efficacy of planned celiac artery coverage during TEVAR.
- To analyze perioperative and long-term results of this technique.
Main Methods:
- Retrospective review of 15 patients who underwent TEVAR with planned CA coverage from 2008-2018.
- Analysis of patient demographics, indications, collateralization, embolization, and clinical outcomes.
Main Results:
- CA coverage provided a mean distal seal extension of 20.3 mm.
- Postoperative complications included splenic infarction/pancreatitis (6.7%) and spinal cord ischemia (13.3%).
- No in-hospital mortality; 86.7% of aneurysms were stable or reduced in size at follow-up.
Conclusions:
- Planned CA coverage is safe and effective for achieving adequate distal sealing in selected TEVAR patients.
- Further large prospective studies are needed to confirm long-term efficacy, especially given potential limitations in sealing length.
Background:
In thoracic endovascular aortic repair (TEVAR), covering the celiac artery (CA) is sometimes necessary to secure the distal seal. We report the outcomes of planned CA coverage in our experience with TEVAR.
Methods:
Cases requiring CA coverage during TEVAR from October 2008 to September 2018 were retrospectively reviewed. Patient demographics, indications for CA coverage, communication between the CA and the superior mesenteric artery (SMA), concomitant CA embolization, and perioperative and late results were collected in a prospective database and analyzed.
Results:
During the study decade, 357 patients underwent TEVAR at our institution. Of these patients, 15 (4.2%) required CA coverage. All 15 patients were male, and the mean age was 72.8 years (range, 44-80 years). The mean aneurysm size was 67.5 mm (range, 50-82 mm). The etiologies included 10 degenerative aneurysms (66.7%; 2 ruptures [13.3%], 4 dissecting aneurysms [26.7%], and 1 case of type IB endoleak [6.7%]) after TEVAR. Communicating collaterals between the CA and the SMA were confirmed by preoperative computed tomography angiography in eight patients (53.3%) and by intraoperative angiography in four patients (26.7%). Seven patients (46.7%) underwent concomitant embolization of the CA. CA coverage offered a mean extension of 20.3 mm (range, 12-22 mm) in the length of the distal seal. Postoperative computed tomography angiography revealed a type IB endoleak that resolved spontaneously in one patient (6.7%). Postoperative complications included splenic infarction/pancreatitis in one patient (6.7%) and spinal cord ischemia in two patients (13.3%). There were no cases of postoperative in-hospital mortality. During the follow-up period (mean, 3.6 years; range, 0.9-8.0 years), two patients developed a new type IB endoleak. One patient underwent distal extension of the stent graft with ilio-SMA bypass, and one patient was observed conservatively in accordance with the patient's decision. There were no cases of type II endoleak via the CA. Most aneurysms (86.7%) were stable or reduced in size at the most recent follow-up. There were no cases of targeted aneurysm-related death during the follow-up period.
Conclusions:
Our study demonstrates the safety and efficacy of CA coverage in facilitating adequate distal sealing in selected patients undergoing TEVAR. Because the distal sealing length is not completely sufficient in most cases requiring CA coverage, the long-term efficacy of CA coverage during TEVAR should be determined in a large prospective study.
