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The Risks of Celiac Artery Coverage During Endoluminal Repair of Thoracic and Thoracoabdominal Aortic Aneurysms

Southern Arizona Veterans Affairs Health Care System (SAVAHCS), Tucson, Arizona, luis.leon{at}va.gov, University of Arizona Health Science Center (AHSC), Tucson, Arizona

Joseph L. Mills, Sr, MD

University of Arizona Health Science Center (AHSC), Tucson, Arizona, Southern Arizona Veterans Affairs Health Care System (SAVAHCS), Tucson, Arizona

William Jordan, MD

University of Alabama, Birmingham

Mark M. Morasch, MD

North-western University Medical Center, Chicago, Illinois

Margaret Kovacs, EdD, RNC

Baptist Cardiac & Vascular Institute of Miami, Miami, Florida

Gary J. Becker, MD

Southern Arizona Veterans Affairs Health Care System (SAVAHCS), Tucson, Arizona, University of Arizona Health Science Center (AHSC), Tucson, Arizona

Bulent Arslan, MD

University of Virginia Health System, Charlottesville, Virginia

The risks of purposeful celiac artery coverage during endovascular thoracic aortic aneurysm repair (TEVAR) to obtain an adequate distal landing zone have received scant scientific attention. Patients undergoing TEVAR at 6 tertiary centers from January 2000 to June 2007 were identified (n = 434); cases requiring celiac artery exclusion (n = 19; 4.4% of the total) were analyzed. The mean follow-up was 8.7 months (range, 0.2-21.2). The mean patients' age was 73.6 years (range, 56-86); 57.9% were men. The mean aneurysm diameter was 6.7 cm (range, 5-8.6). In 2 patients, the celiac artery balloon occlusion test was performed prior to TEVAR. In both, intact collateral foregut circulation was seen. Both underwent TEVAR without celiac artery revascularization; 1 did well, whereas the other developed foregut ischemia. In 16 cases (84.2%), the celiac artery was not revascularized prior to TEVAR. In those patients, 19 complications were reported (3 deaths; 2 paraplegia). No similar events occurred in those who underwent celiac artery revascularization (n = 3). Celiac artery coverage during TEVAR is required in 4.4% of cases. TEVAR correlated with a nonnegligible number of major complications. Complications were more frequent and severe in patients who did not have celiac artery revascularization prior to TEVAR. Specific celiac artery coverage complications are rare and not readily predictable based on preprocedure arteriography.

Key Words: TEVAR • thoracoabdominal aortic aneurysm • bowel ischemia • paraplegia

This version was published on February 1, 2009

Vascular and Endovascular Surgery, Vol. 43, No. 1, 51-60 (2009)
DOI: 10.1177/1538574408322655


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