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Home > Vascular Annual Meeting > mehta_coverage_celiac_artery

Coverage of Celiac Artery During Thoracic Endovascular Aneurysm Repair: Outcomes of a Prospective Analysis

R. Clement Darling III, Manish Mehta, Sean P. Roddy, Yaron Sternbach, John B Taggert, Philip S K Paty, Paul B Kreienberg, Kathleen J. Ozsvath, Benjamin B Chang, Dhiraj M Shah
Albany Medical College, Albany, NY

OBJECTIVES: Successful thoracic endovascular aneurysm repair (TEVAR) requires adequate proximal and distal fixation and seal. We report our experience of planned celiac artery coverage during endovascular repair of complex thoracic aortic aneurysms (TAA).

METHODS: Since 2004, 165 patients underwent TEVAR under elective (n=113, 68%) and emergent circumstances (52, 32%). Patients with inadequate distal stentgrafts landing zones during TEVAR underwent detailed evaluation of the gastroduodenal arcade with communicating collaterals between the celiac and superior mesenteric artery (SMA) by CTA and intraoperative arteriogram. If needed, in presence of a patent SMA and demonstration of collaterals to the celiac artery, the stentgrafts were extended to the SMA with celiac artery coverage. Instances when further lengthening of distal thoracic stentgraft landing zone was needed to obtain an adequate seal, the SMA was partially covered with the endograft, and a balloon expandable stent routinely deployed in proximal SMA to maintain patency. Outcomes data was prospectively collected and analyzed retrospectively.

RESULTS: 21 of 165 (13%) patients with TEVAR required celiac artery interruption; 16 (76%) had demonstrable collaterals to the SMA. 7 of 21 (33%) patients underwent additional partial SMA coverage by stentgraft and proximal SMA stent. Endoleaks from distal fixation sites were noted in 4 patients; 1 Type I and 3 Type II (retrograde flow via the celiac artery), all successfully treated by transfemoral coil embolization. One (4.8%) patient without angiographic evidence of SMA-celiac collaterals developed shock liver within 18 hours and underwent hepatic artery revascularization without success and died. In mean follow-up of 15 months, there were no other complications of mesenteric ischemia, spinal cord ischemia, SMA in-stent stenosis, or conversion to open surgical repair.

CONCLUSIONS: Our findings suggest that celiac artery coverage to facilitate adequate distal sealing during TEVAR with complex TAA is relatively safe in the presence of SMA-celiac collaterals. Endoleaks arising from distal stentgrafts attachment site or via retrograde flow from the celiac artery might be difficult to differentiate, and can be successfully managed by transfemoral coil embolization.
AUTHOR DISCLOSURES: M. Mehta, W.L. Gore & Associates; Medtronic AVE; Cordis Endovascular; Medtronic Advisory Board; Cordis Advisory Board; W.L. Gore & Associates; Medtronic; Cordis Endovascular; Y. Sternbach, W.L. Gore & Associates; Medtronic AVE; Cordis Endovascular; J.B. Taggert, W.L. Gore & Associates; Medtronic AVE; Cordis Endovascular; P.S.K. Paty, W.L. Gore & Associates; Medtronic AVE; Cordis Endovascular; S.P. Roddy, W.L. Gore & Associates; Medtronic AVE; Cordis Endovascular; P.B. Kreienberg, W.L. Gore & Associates; Medtronic AVE; Cordis Endovascular; Sanofi/Aventis; K.J. Ozsvath, W.L. Gore & Associates; Medtronic AVE; Cordis Endovascular; S. Saltzberg, W.L. Gore & Associates; Medtronic AVE; Cordis Endovascular; D.M. Shah, W.L. Gore & Associates; Medtronic AVE; Cordis Endovascular; R. Darling, W.L. Gore & Associates; Medtronic AVE; Cordis Endovascular.