Comparative Outcomes after Celiac Artery Revascularization and Coverage during Thoracic Endovascular Aortic Repair
Narek Veranyan, MD, Gregory Magee, Sung W. Ham, Fred A. Weaver, Vincent L. Rowe, Fernando Fleischman.
Keck Hospital of University of South California, Los Angeles, CA, USA.
OBJECTIVE:
Adequate proximal and distal seal zones are necessary for successful thoracic endovascular aortic repair (TEVAR). When the distal extent of aortic pathology is in close proximity to the visceral artery origins, achieving adequate distal seal zone may require celiac artery coverage during TEVAR. Revascularization of the celiac artery is associated with increased operative complexity and may not always be necessary. Outcomes following celiac coverage have been predominantly studied in single-center case series. The objective of this study is to determine the difference in outcomes between celiac coverage with and without revascularization during TEVAR using the Vascular Quality Initiative (VQI) database.
METHODS:
The VQI TEVAR module database was queried for all patients with distal seal zone below the celiac and above the superior mesenteric artery (zone 6). Patients who underwent endovascular or open direct celiac artery revascularization were compared with patients without direct celiac revascularization. The primary outcome was postoperative mortality. Secondary outcomes were postoperative morbidities, including incidence of postoperative mesenteric ischemia, aorta-related mortality, endoleaks, reinterventions, and procedure time.
RESULTS:
One hundred twenty-eight of 9,148 patients who underwent TEVAR in the national VQI database from 2010 to 2017 had a distal landing in zone 6. For these 128 patients, the indication for TEVAR were aneurysm (87, 68%), dissection (18, 14%), dissection with aneurysm (10, 8%) and other (13, 10%). Thirty-seven of 128 patients were coded as having celiac artery revascularization and 91 patients were not coded as having celiac artery revascularization (Table I). Celiac artery revascularization was performed by fenestrated TEVAR (46%), parallel stent grafting (43%), and open bypass grafting (11%). Postoperative mesenteric ischemia was observed in one patient who underwent celiac coverage TEVAR without revascularization. Overall and aorta-related mortality, reinterventions, and complications were not significantly different between groups. Fluoroscopy time and total procedure time were significantly longer for the celiac revascularization group (Table I).
CONCLUSIONS:
Celiac artery revascularization during TEVAR is most commonly performed by fenestrated TEVAR technique. Celiac artery coverage without revascularization during TEVAR was not associated with worse outcomes, however, revascularization should be strongly considered if mesenteric collateral vessels are not present and patent. 
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