Purpose: To report the outcome of intended celiac artery coverage during thoracic endovascular aortic repair (TEVAR) for type B aortic dissection with an intimal tear near the celiac artery (CA) orifice.
Methods: Between 2007 and 2011, 13 patients (10 men; mean age 61.3 years, range 46-70) with type B aortic dissection underwent primary (n=9) or secondary (n=4) TEVAR with intentional CA coverage. Preoperative imaging was performed to confirm the existence of collateral circulation between the celiac artery and superior mesenteric artery. A short stent-graft was then deployed to cover both the entry tear and the CA. Follow-up was at 2 weeks; 1, 3, and 6 months; and every year thereafter. Preoperative diameters of the true and false lumens at the CA level, 8 cm above the CA, and at the aortic bifurcation, along with the maximum aortic diameter in the dissected segment, were compared to similar measurements at 6 months.
Results: All stent-graft procedures were successful and without complication. No immediate or delayed endoleak was identified in 8 of 13 patients over a mean 25-month follow-up (range 3-38). The other 5 patients had type II endoleak on completion imaging; these all resolved within 3 months after operation. Postoperative blood liver function and amylase assays were normal in all patients. No abdominal symptoms or signs of spinal cord ischemia were discovered. Expansion of the true lumen after TEVAR was statistically significant vs. at baseline in both groups (primary p<0.001, secondary p=0.023). Both the false lumen and the entire aorta showed signs of shrinkage after TEVAR in the 2 groups as well, although only the secondary group showed significant change (p<0.005) vs. baseline.
Conclusion: TEVAR with intentional CA coverage is effective in excluding an infradiaphragmatic entry tear near the CA level. The incidence of abdominal ischemia is low if collateral circulation has been confirmed preoperatively. Type II endoleak is a major complication, yet most cease under observation.