Intentional Overstenting of the Celiac Trunk During Thoracic Endovascular Aortic Repair: Preoperative Role of Multislice CT Angiography

Abstract

Purpose:

To report initial experience with intentional coverage of the celiac trunk to expand the distal landing zone in thoracic endovascular aortic repair (TEVAR) and to analyze preprocedural visualization of collateral blood flow by noninvasive computed tomographic angiography (CTA).

Methods:

Between January 1997 and April 2008, 202 patients with thoracic aortic pathologies were treated by TEVAR. In 5 high-risk patients (3 women; mean age 73 years, range 62–88), intentional overstenting of the celiac trunk was performed when treating 2 ruptured aneurysms, 1 penetrating aortic ulcer, 1 type B dissection, and 1 distal type I endoleak. Multislice CTA (MSCTA) with multiplanar reconstruction was used to visualize the visceral collaterals; no angiography was performed.

Results:

MSCTA was able to visualize the patent pancreaticoduodenal artery and other collaterals and to verify sufficient collateral blood flow. All celiac arteries were patent preoperatively; only 1 severe stenosis was demonstrated. After successful TEVAR in all cases, 1 of the 5 patients developed visceral malperfusion and died of multiorgan failure 1 day after TEVAR of a ruptured thoracic aneurysm. A second patient died 6 weeks postoperatively due to cardiopulmonary failure (non-procedure-related). There were no late complications or reinterventions.

Conclusion:

Overstenting of the celiac trunk is feasible, with acceptable risk in emergency cases and high-risk patients if MSCTA documents collateral blood flow. Noninvasive MSCTA is sufficient and may obviate pre- and intraoperative selective angiography with or without a balloon occlusion test.

Keywords

thoracic aortic pathology thoracic endovascular aortic repair overstenting celiac trunk aorta stent-graft multislice computed tomographic angiography

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