Section of Vascular Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
J Vasc Surg. 2013 Jul;58(1):270-5. doi: 10.1016/j.jvs.2013.04.003. Epub 2013 May 24.
Intentional coverage of the celiac artery (CA) can extend the distal landing zone necessary for thoracic endovascular aortic repair. A comprehensive review identified 93 cases in 17 reports describing this technique. The majority (87%) were elective procedures. Prior to endograft deployment, 21 patients underwent CA embolization. Of the remaining, three developed type II endoleaks from the CA requiring treatment. The superior mesenteric artery (SMA) was stented in 18 patients during the operative procedure, with one patient undergoing delayed stent placement. There were five iliac artery injuries but no other intraoperative complications. The 30-day mortality rate was 9.7% with three cases attributed to foregut ischemia. Overall, this procedure is technically safe but is associated with a significant risk of death and morbidity. Furthermore, durability is unclear as long-term data are lacking. Careful patient selection, preoperative determination of adequate CA-SMA collaterals, and demonstration of postprocedure SMA patency are all mandatory components of this procedure. However, the development of foregut ischemia cannot be reliably predicted, and patients should be monitored closely for this unique postoperative complication.
可以覆盖腹主动脉（CA）以延长胸主动脉血管内修复术所需的远端着陆区。全面回顾在 17 份报告中确定了 93 例描述该技术的病例。大多数（87%）是选择性手术。在支架移植物植入前，21 例患者接受了 CA 栓塞术。在其余的患者中，有 3 例因 CA 发生 II 型内漏而需要治疗。在手术过程中，18 例患者进行了肠系膜上动脉（SMA）支架置入术，其中 1 例患者进行了延迟支架置入术。有 5 例髂动脉损伤，但没有其他术中并发症。30 天死亡率为 9.7%，其中 3 例归因于前肠缺血。总的来说，该手术在技术上是安全的，但与较高的死亡率和发病率相关。此外，由于缺乏长期数据，其耐久性尚不清楚。仔细的患者选择、术前确定足够的 CA-SMA 侧支以及证明术后 SMA 通畅性是该手术的强制性组成部分。然而，前肠缺血的发展无法可靠预测，应密切监测患者以避免这种独特的术后并发症。
