Outcomes of celiac artery stenting after fenestrated endovascular aneurysm repair (FEVAR) using custom-made devices
Ryan Meehan, MD1, David Timaran, MD1, Lucyna Cieciura, MD1, Robert C. Allen, MD1, Martyn Knowles, MD2, Carlos Timaran, MD1.
1University of Texas Southwestern, Dallas, TX, USA, 2University of North Carolina, Chapel Hill, NC, USA.
Background: Celiac artery stenting outcomes may be affected by median arcuate ligament compression and preexisting stenosis. Recently, endovascular repair of complex aortic aneurysms that include celiac artery stenting have become an option for patients not eligible for standard endovascular repair (EVAR). Outcomes of celiac artery stenting during FEVAR are still under investigation. The aim of this study is to assess perioperative and 6-month outcomes of celiac artery stenting during FEVAR using custom-made devices (CMDs).
Methods: Over a 28-month period, 48 patients underwent FEVAR using CMDs. A single institutional study was completed to evaluate outcomes of celiac artery stents performed during FEVAR using CMDs. Celiac artery patency was defined by arterial duplex data and CT angiography.
Results: 39 men (81%) and 9 women (19%) with a median age of 72 years ([IQR], 66-77) underwent FEVAR using CMDs. The median number of fenestrations was 4 (IQR, 3-4). All fenestrations were stented using balloon-expandable covered stents. Stenting of the celiac artery was performed in 30 patients (64%). The median diameter of the celiac artery was 8 mm (IQR, 6.7-9), the median preoperative peak systolic velocity (PSV) at the proximal end of the vessel was 132 cm/s (IQR, 100-169). The median size of celiac stents used was 7mm (IQR, 8-9). Preoperatively, 18 patients (38%) had celiac stenosis of 25% or higher and 2 of 50% (6%). Technical success for intended celiac artery stenting was 100%. At 30 days, stenosis higher than 50% in CTA was evident in 2 patients (6%). The median postoperative PSV was144 cm/s (IQR, 121-165) for all patients. At 6 months, no patients had significant stenosis (>50%) of the celiac stent on CTA with a median PSV of 184 cm/s (IQR, 121-203). Primary patency for the celiac artery stents at 6 months was 100%. The rate of celiac artery stent adverse events was 3% at 30-days. This was a type 1c endoleak that resolved after restenting. No complications related to celiac artery stent patency failure were present at 6 months post FEVAR.
Conclusions: Celiac artery stenting during FEVAR using CMDs has a high technical success rate with primary patency of 100% at 6 months. Celiac artery stents may be a source of endoleaks after FEVAR. Preoperative stenosis or vessel compression do not affect early outcomes.
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