Outcome after celiac artery coverage during endovascular thoracic aortic aneurysm repair: preliminary results.

BACKGROUND: Endovascular repair of descending thoracic aortic aneurysms has emerged as an alternative to open repair. Coverage of the left subclavian origin has been reported to expand the proximal sealing zone. We report the planned coverage of the celiac artery origin with a thoracic stent graft to achieve an adequate distal sealing zone. METHODS: All patients undergoing endovascular aneurysm repair are prospectively entered into a computerized database. All patients who underwent thoracic endovascular aneurysm repair with coverage of the celiac artery origin were identified and retrospectively analyzed. End points for evaluation included indications for covering the celiac artery, anatomic features of the distal landing zone, demonstration of collateral circulation between the celiac artery and the superior mesenteric artery, technical success of the procedure, and presence of clinical ischemic symptoms after the procedure. RESULTS: Between March 2005 and May 2006, 46 patients underwent endovascular repair of descending thoracic aortic aneurysms. Seven patients had planned celiac artery coverage with a thoracic stent graft to secure an adequate distal sealing zone. Six patients demonstrated collateral circulation through the gastroduodenal artery between the celiac and superior mesenteric arteries before deployment of the stent graft. One patient had a distal type I endoleak at the conclusion of the procedure related to inadequate sealing at the superior mesenteric artery origin. No type II endoleaks were evident at the final intraoperative angiogram or 30-day computed tomography scan. There were no postoperative deaths, no ischemic abdominal complications, and no clinical spinal cord ischemia. Short-term follow-up (1 to 10 months) has demonstrated no additional endoleaks (type I not fully assessed), no aneurysm growth, and no aneurysm ruptures. CONCLUSION: This limited series supports the suitability, in selected patients, of covering the celiac artery origin for a distal landing zone when the distal sealing zone proximal to the celiac artery is inadequate. We recommend the angiographic evaluation of the collateral circulation between the celiac and superior mesenteric arteries when covering the celiac artery origin is being considered.

Ruptured abdominal aortic aneurysm: a retrospective assessment of open versus endovascular repair.

Aortic stent graft repair has recently been applied as an alternative therapy for infrarenal ruptured abdominal aortic aneurysms (rAAAs). We retrospectively assessed outcome in a continuous series at a single institution (an academic tertiary referral center) of patients with infrarenal rAAAs treated by either open or endovascular repair. Between October 1999 and July 2004, 24 patients were treated at the University of Alabama Hospital for infrarenal rAAA. They were treated by either open procedure (n = 15) or endovascular stent graft repair (n = 9). Outcome parameters included mortality, morbidity, procedure time, blood loss, and length of stay. Endovascular aneurysm repair (EVAR) was performed whenever the anatomy was deemed suitable and experienced personnel were available. Age (mean 70.8 years for EVAR vs. 72.2 years for open), gender (men 71% vs. women 75%), AAA size (mean 6.7 vs. 6.4 cm), early mortality (22% vs. 26%), and major morbidity (56% vs. 53%) were similar in both groups. Blood loss difference between the two groups was statistically significant (p = 0.0001). Our series supports the feasibility and short-term viability of EVAR for infrarenal rAAA when anatomy is suitable and patient and facility conditions are favorable.