Coverage of the celiac artery during TEVAR: is it ever appropriate?

Adequate seal at the proximal and distal extent of stent grafts in the aorta is paramount to the success of thoracic endovascular aortic repair (TEVAR). Thoracoabdominal aneurysms pose a formidable challenge given their extension into the arch branches proximally and the visceral segment distally. Extension of the landing zone of even 3 to 5 mm can possibly increase the durability of the stent graft and may decrease the chances of future migration or collapse. Although coverage of the subclavian artery to extend the proximal landing zone has been met with initial success, the outcome of coverage of the celiac axis in order to extend the distal landing zone has not been as well studied. Because of the abundance of rich collateral vessels in the foregut, it has been perceived as a potentially safe practice. However, careful angiographic anatomic delineation and patient selection is vital to determine whether concomitant revascularization procedures are warranted.