Intentional coverage of the celiac artery during thoracic endovascular aortic repair

Abstract

Intentional coverage of the celiac artery (CA) can extend the distal landing zone necessary for thoracic endovascular aortic repair. A comprehensive review identified 93 cases in 17 reports describing this technique. The majority (87%) were elective procedures. Prior to endograft deployment, 21 patients underwent CA embolization. Of the remaining, three developed type II endoleaks from the CA requiring treatment. The superior mesenteric artery (SMA) was stented in 18 patients during the operative procedure, with one patient undergoing delayed stent placement. There were five iliac artery injuries but no other intraoperative complications. The 30-day mortality rate was 9.7% with three cases attributed to foregut ischemia. Overall, this procedure is technically safe but is associated with a significant risk of death and morbidity. Furthermore, durability is unclear as long-term data are lacking. Careful patient selection, preoperative determination of adequate CA-SMA collaterals, and demonstration of postprocedure SMA patency are all mandatory components of this procedure. However, the development of foregut ischemia cannot be reliably predicted, and patients should be monitored closely for this unique postoperative complication.