Background
Studies have previously identified increased morbidity and mortality with celiac artery
coverage during thoracic endovascular aortic repair (TEVAR) for aneurysmal disease.
This study aimed to delineate the risks associated with celiac artery coverage in
all patients undergoing TEVAR for dissection, trauma, or aneurysmal disease.
Methods
Using the Vascular Quality Initiative database, we identified all patients undergoing
TEVAR from 2012 to 2020 and categorized them based on the underlying pathology (aneurysm,
dissection, or acute/trauma). Patients were excluded if their endograft was deployed
distal to aortic zone 6 or if they had any preoperative/operative celiac revascularization
procedure. Univariate, regression, and Kaplan–Meier analysis were performed for all
3 groups, focusing on postoperative complications and survival.
Results
There were 8,265 patients who underwent TEVAR over the 8-year study period with 142
(1.7%) having celiac artery coverage during their index procedure. Of those patients,
the celiac artery was covered during TEVAR in 1.2% of patients with dissection, 1.3%
with aneurysm, and 0.7% with trauma. On unadjusted analysis, celiac artery coverage
in TEVAR for aneurysmal disease was associated with increased in-hospital mortality
(16% vs. 5%, P < 0.001), 30-day mortality (33% vs. 23%, P = 0.029), any postoperative complication (excluding death) (42% vs. 25%, P < 0.001), and postoperative bowel complication (3% vs. 0.7%, P = 0.003). There were no differences in outcomes for patients treated with celiac
coverage versus those without celiac coverage during TEVAR for dissection or trauma
on univariate analysis. After risk adjustment, celiac artery coverage remained predictive
of worse postoperative outcomes in patients with aneurysmal disease: in-hospital mortality
(odds ratio [OR] = 3.6, confidence interval [CI] 1.8–6.9), 30-day death (OR = 1.6,
CI 1.0–2.4), any postoperative complication (OR 2.2, CI 1.4–3.5), and bowel-specific
postoperative complication (3.3, CI 1.0–10.8). There were no differences in patient
outcomes for those treated with celiac coverage versus those without celiac coverage
during TEVAR for dissection or trauma on multivariate analysis. Kaplan–Meier curves
show a significant difference in overall survival based on pathology, specifically
lower survival rates for patients with celiac coverage treated for aneurysmal disease.
Cox regression analysis showed that celiac artery coverage for aneurysmal disease
was associated with significantly increased hazard ratio affecting overall survival
(hazard ratio = 2.6, P < 0.001), but there was no impact on survival in patients who underwent TEVAR with
celiac coverage for dissection or trauma.
Conclusions
Celiac artery coverage for patients with aneurysmal disease was correlated with a
significant increase in postoperative morbidity, mortality, and lowers overall survival.
However, for patients with dissection or acute/traumatic aortic pathology, celiac
artery coverage does not portend worse outcomes.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Annals of Vascular SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Intentional coverage of the celiac artery during thoracic endovascular aortic repair.J Vasc Surg. 2013; 58: 270-275
- Anatomical variations of the celiac trunk: a systematic review.Arq Bras Cir Dig. 2018; 31: e1403
- Outcomes after celiac artery coverage during thoracic endovascular aortic aneurysm repair.J Vasc Surg. 2015; 62: 36-42
- Outcomes of planned celiac artery coverage during TEVAR.J Vasc Surg. 2010; 52: 1153-1158
- Using the Vascular Quality Initiative to improve quality of care and patient outcomes for vascular surgery patients.Semin Vasc Surg. 2015; 28: 97-102
- Thoracoabdominal aneurysm repair: hybrid versus open repair.J Vasc Surg. 2009; 50: 15-22
- Radical distal pancreatectomy with en bloc resection of the celiac artery, plexus, and ganglions for advanced cancer of the pancreatic body: a preliminary report on perfect pain relief.JOP. 2001; 2: 93-97
- Resection of the celiac axis for invasive pancreatic cancer.J Gastrointest Surg. 2005; 9: 503-507
- Acute pancreatitis caused by pancreatic ischemia after TEVAR combined with intentional celiac artery coverage and embolization of the branches of the celiac artery.J Surg Case Rep. 2017; 2017: rjx029
- Chronic mesenteric ischemia after partial coverage of the celiac artery during TEVAR, case report, and review of the literature.Ann Vasc Surg. 2014; 28: 1935.e1-1935.e6
- Multislice CT angiography of the celiac and superior mesenteric arteries: comparison with arteriographic findings.Radiol Med. 2002; 103: 456-463
- Early and midterm outcomes of celiac artery coverage during thoracic endovascular aortic repair.J Vasc Surg. 2020; 72: 1552-1557
- Midterm results of intentional celiac artery coverage during TEVAR for type B aortic dissection.J Endovasc Ther. 2013; 20: 276-282
- Clinical outcome of endovascular therapeutic occlusion of the celiac artery.J Vasc Surg. 2007; 46: 655-661
- Occlusion of the celiac artery during endovascular thoracoabdominal aortic aneurysm repair is associated with increased perioperative morbidity and mortality.Ann Vasc Surg. 2020; 66: 200-211
Article info
Publication history
Published online: December 15, 2022
Accepted:
November 6,
2022
Received:
July 7,
2022
Footnotes
Vascular Annual Meeting, Interactive Poster Session, 2021, San Diego, California.
Table of Contents Summary: Celiac artery coverage during thoracic endovascular aortic repair (TEVAR) was predictive of worse outcomes in patients with aneurysm regarding in-hospital mortality, 30-day death, any postoperative complication, and bowel-specific postoperative complication. Consideration of celiac artery revascularization or sparing during TEVAR for aneurysmal disease is merited but not during TEVAR for dissection or trauma pathology.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
