Safety and Efficacy of Intentional Celiac Artery Coverage in Endovascular Management of Thoracoabdominal Aortic Diseases: A Systematic Review and Meta-analysis

2021 ◽  
pp. 152660282110594
Author(s):  
Christos Argyriou ◽  
Stavros Spiliopoulos ◽  
Konstantinos Katsanos ◽  
Nikolaos Papatheodorou ◽  
Miltos K. Lazarides ◽  
...  

Purpose: Thoracic endovascular aortic aneurysm repair (TEVAR) has emerged as an attractive alternative option in the treatment of thoracoabdominal aortic aneurysm (TAAA) diseases, reporting lower morbidity and mortality rates compared with open or hybrid repair. A challenging situation arises when the aneurysm involves the celiac artery (CA), precluding a safe distal landing zone. We investigated the safety and efficacy of CA coverage in the treatment of complex TAAA diseases during endovascular management. Materials and Methods: A review of the literature was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. The electronic bibliographic sources searched were MEDLINE and SCOPUS databases. Primary outcomes of interest were perioperative and 30-day mortality. Any type of endoleak, mesenteric ischemia, perioperative spinal cord ischemia, and reintervention rates were secondary end points. A random-effects meta-analysis was performed. Summary statistics of event risks were expressed as proportions and 95% confidence interval (CI). Results: Ten observational cohort studies published between 2009 and 2020, reporting a total of 175 patients, were eligible for quantitative synthesis. Indications for TEVAR were primary TAAAs in 82% of patients, aortic dissection in 14% of patients, type Ib endoleak after previous endograft deployment in 3% of patients, and penetrating aortic ulcer in 1 patient. Reintervention rate was 9% (95% CI, 4%–20%) and spinal cord ischemia was 7% (95% CI, 4%–-12%). Type II endoleak was the predominant type of endoleak in 10% of patients (95% CI, 4%–22%), followed by type I endoleak in 5% of patients (95% CI, 2%–12%) and type III endoleak in 1% (95% CI, 0%–16%) of patients. Mesenteric ischemia occurred in 6% of patients (95% CI, 3%–10%). Thirty-day mortality was 5% (95% CI, 2%–13%) and the pooled estimate for overall mortality was 21% (95% CI, 14%–31%). Conclusions: Celiac artery coverage during TEVAR is a challenging but feasible option for the treatment of TAAA diseases, providing acceptable morbidity and mortality rates. Demonstration of adequate visceral collateral pathways before definitive CA coverage is the sine quo non for the success of the technique.

2005 ◽  
Vol 42 (4) ◽  
pp. 608-614 ◽  
Author(s):  
Noud Peppelenbosch ◽  
Philippe W.M. Cuypers ◽  
Anco C. Vahl ◽  
Frank Vermassen ◽  
Jacob Buth

2014 ◽  
Vol 60 (5) ◽  
pp. 1399
Author(s):  
Sean C. Hanley ◽  
Daniel Obrand ◽  
Oren Steinmetz ◽  
Kent Mackenzie ◽  
Michel Corriveau ◽  
...  

1994 ◽  
Vol 20 (5) ◽  
pp. 826-833 ◽  
Author(s):  
Naoya Yamamoto ◽  
Haruo Takano ◽  
Hideki Kitagawa ◽  
Yoshiharu Kawaguchi ◽  
Haruo Tsuji ◽  
...  

Author(s):  
Carl Ying ◽  
Minh Chau Joe Tran

In this chapter the essential aspects of anesthesia for abdominal aortic aneurysm (AAA) repair are discussed. Subtopics include airway management in expanding aneurysm, hemodynamic therapy, monitoring, vasodilator therapy, and bleeding. The chapter is divided into preoperative, intraoperative, and postoperative sections with important subtopics related to the main topic in each section. Preoperative topics include medications, assessment of cardiac status, and hemodynamic goals for this surgery. Issues discussed related to intraoperative management include monitoring, induction, maintenance, and aortic cross-clamping and unclamping. Postoperative concerns discussed include extubation, decreased renal function, spinal cord ischemia, and other complications affecting the cardiovascular, respiratory, renal, and gastrointestinal systems.


2011 ◽  
Vol 77 (7) ◽  
pp. 832-838 ◽  
Author(s):  
William B. Newton ◽  
Matthew J. Sagransky ◽  
Jeanette S. Andrews ◽  
Kimberly J. Hansen ◽  
Matthew A. Corriere ◽  
...  

This report examines outcomes of revascularization for acute arterial mesenteric ischemia (AAMI) using the American College of Surgeons National Surgical Quality Improvement Program database. Patients with International Classification of Diseases, 9th Revision and Current Procedural Terminology codes indicating AAMI with concomitant mesenteric revascularization were identified. Demographic, risk factor, procedural, morbidity, and mortality data were examined. Associations with morbidity and mortality were analyzed by logistic regression. One hundred forty-two cases of AAMI were identified. Seventy-one cases were thrombotic and 71 were embolic according to revascularization codes. Mean age was 66 years, 84 per cent of patients were white, and 54 per cent were female. Unadjusted major morbidity and mortality rates were 69 and 30 per cent, respectively. Patients with thrombotic AAMI were more likely to have a lower body mass index, greater than 10 per cent weight loss in the past 6 months, and a history of smoking. Patients with embolic AAMI were more likely to present emergently with sepsis. Unadjusted morbidity and mortality rates were 78 and 38 per cent for embolic and 61 and 23 per cent for thrombotic AAMI, respectively. Multi-variable predictors of morbidity included bowel resection at the time of revascularization, transfer admission, and involvement of a surgical resident. Multivariable predictors of mortality included impaired functional status, increased age, and postoperative sepsis. Cause of AAMI was not a significant predictor of morbidity or mortality. In a large sample of AAMI cases, AAMI remained a highly lethal and morbid condition. Predictors of morbidity and mortality included indicators of advanced presentation, treatment delay, and patient-related factors specific to AAMI, including debility and advanced age. Efforts directed at prevention and increasing the speed of diagnosis and definitive treatment appear to be necessary to improve outcomes.


Cells ◽  
2020 ◽  
Vol 9 (2) ◽  
pp. 501 ◽  
Author(s):  
Florian Simon ◽  
Markus Udo Wagenhäuser ◽  
Albert Busch ◽  
Hubert Schelzig ◽  
Alexander Gombert

Spinal cord ischemia (SCI) is a clinical complication following aortic repair that significantly impairs the quality and expectancy of life. Despite some strategies, like cerebrospinal fluid drainage, the occurrence of neurological symptoms, such as paraplegia and paraparesis, remains unpredictable. Beside the major blood supply through conduit arteries, a huge collateral network protects the central nervous system from ischemia—the paraspinous and the intraspinal compartment. The intraspinal arcades maintain perfusion pressure following a sudden inflow interruption, whereas the paraspinal system first needs to undergo arteriogenesis to ensure sufficient blood supply after an acute ischemic insult. The so-called steal phenomenon can even worsen the postoperative situation by causing the hypoperfusion of the spine when, shortly after thoracoabdominal aortic aneurysm (TAAA) surgery, muscles connected with the network divert blood and cause additional stress. Vessels are a conglomeration of different cell types involved in adapting to stress, like endothelial cells, smooth muscle cells, and pericytes. This adaption to stress is subdivided in three phases—initiation, growth, and the maturation phase. In fields of endovascular aortic aneurysm repair, pre-operative selective segmental artery occlusion may enable the development of a sufficient collateral network by stimulating collateral vessel growth, which, again, may prevent spinal cord ischemia. Among others, the major signaling pathways include the phosphoinositide 3 kinase (PI3K) pathway/the antiapoptotic kinase (AKT) pathway/the endothelial nitric oxide synthase (eNOS) pathway, the Erk1, the delta-like ligand (DII), the jagged (Jag)/NOTCH pathway, and the midkine regulatory cytokine signaling pathways.


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