Coverage of the Coeliac Artery During Thoracic Endovascular Aortic Repair: A Systematic Review and Meta-Analysis

Abstract

Objective: To investigate the clinical impact of coeliac artery (CA) coverage during thoracic endovascular aortic repair (TEVAR).

Methods: This systematic review and meta-analysis was conducted according to the PRISMA guidelines. Electronic databases were searched from 1989 to 2020 for studies reporting visceral ischaemia, spinal cord ischaemia (SCI), 30 day/in hospital mortality, endoleaks, re-intervention, and caudal stent graft migration following CA coverage in patients undergoing TEVAR. Meta-analysis was conducted using random effects modelling. The quality of the evidence was graded using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach.

Results: Fifteen observational studies with 236 patients (108 male, age range 61.3 - 79 years) were included. The pooled visceral ischaemia rate was 13% with significant heterogeneity between studies (95% confidence intervals [CI] 4 - 24; I² = 72%, p < .001). The SCI rate was 5% (95% CI 2 - 9; I² = 0%); the 30 day/in hospital mortality was 4% (95% CI 1 - 7; I² = 0%); the overall endoleak rate was 21% (95% CI 13 - 29; I² = 35%) with a 5% (95% CI 0 - 13; I² = 38%) rate of type Ib and 2% (95% CI 0 - 8; I² = 43%) rate of type II endoleak from retrograde CA flow. The re-intervention rate was 13% (95% CI 6 - 22; I² = 54%); the caudal stent graft migration rate was 3% (95% CI 0 - 9, I² = 0%). The certainty of the body of evidence was judged to be very low for all outcomes.

Conclusion: CA coverage during TEVAR is associated with high rates of visceral ischaemia, spinal cord ischaemia, 30 day/in hospital mortality, endoleaks, and re-intervention. Although the literature is of poor quality and questions remain over effects estimates, there is evidence that CA coverage should be avoided if at all possible, during TEVAR.

Registration: PROSPERO registration number 244084.

Keywords: 30 day mortality; Coeliac artery coverage; Endoleak; Scallop endografts; Spinal cord ischaemia; Thoracic endovascular aortic repair; Visceral ischaemia.