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Bernhard Glodny - One of the best experts on this subject based on the ideXlab platform.
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Clinical outcome of endovascular therapeutic occlusion of the Celiac Artery.
Journal of vascular surgery, 2007Co-Authors: Peter Waldenberger, Nadine Bendix, Johannes Petersen, Thomas Tauscher, Bernhard GlodnyAbstract:Objective Endovascular occlusion of the Celiac Artery can be performed along with occlusion of a Celiac trunk aneurysm or stenting of a thoracoabdominal aortic aneurysm to prevent a type II endoleak. Because only a few individual cases have been previously available for study, the aim of this study was to examine the technical details, clinical course, and outcome of this procedure based on a group of patients. Methods This retrospective study included 10 patients who underwent endovascular occlusion of the Celiac Artery between 1998 and 2006 (female/male = 1:4, mean age, 62.5 ± 9.8 years). There were five aneurysms of the Celiac Artery, two cases each of thoracoabdominal aortic aneurysms and dissecting thoracoabdominal aortic aneurysms, and one mycotic pseudoaneurysm of the aorta. The mean follow-up period was 21.4 ± 29.1 months. Results The Celiac Artery was successfully occluded in all cases, along with exclusion of the Celiac Artery aneurysm or thoracoabdominal aortic aneurysm, respectively. The pancreaticoduodenal arteries were the main collateral pathways, but other anastomoses and, especially, vascular variations of the Celiac Artery and its territory were also significant. In one patient, abdominal angina was treated by percutaneous angioplasty and stenting of the superior mesenteric Artery. Conclusions Endovascular occlusion of the Celiac Artery is both safe and feasible. Some vascular variations may make occlusion of the Celiac trunk impossible. Liver function disorder is a relative contraindication for this procedure.
William D. Jordan - One of the best experts on this subject based on the ideXlab platform.
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The Risks of Celiac Artery Coverage During Endoluminal Repair of Thoracic and Thoracoabdominal Aortic Aneurysms
Vascular and endovascular surgery, 2008Co-Authors: Luis R. Leon, Joseph L. Mills, William D. Jordan, Mark M. Morasch, Margaret Kovacs, Gary J. Becker, Bulent ArslanAbstract:The risks of purposeful Celiac Artery coverage during endovascular thoracic aortic aneurysm repair (TEVAR) to obtain an adequate distal landing zone have received scant scientific attention. Patients undergoing TEVAR at 6 tertiary centers from January 2000 to June 2007 were identified (n = 434); cases requiring Celiac Artery exclusion (n = 19; 4.4% of the total) were analyzed. The mean follow-up was 8.7 months (range, 0.2-21.2). The mean patients' age was 73.6 years (range, 56-86); 57.9% were men. The mean aneurysm diameter was 6.7 cm (range, 5-8.6). In 2 patients, the Celiac Artery balloon occlusion test was performed prior to TEVAR. In both, intact collateral foregut circulation was seen. Both underwent TEVAR without Celiac Artery revascularization; 1 did well, whereas the other developed foregut ischemia. In 16 cases (84.2%), the Celiac Artery was not revascularized prior to TEVAR. In those patients, 19 complications were reported (3 deaths; 2 paraplegia). No similar events occurred in those who underwent Celiac Artery revascularization (n = 3). Celiac Artery coverage during TEVAR is required in 4.4% of cases. TEVAR correlated with a nonnegligible number of major complications. Complications were more frequent and severe in patients who did not have Celiac Artery revascularization prior to TEVAR. Specific Celiac Artery coverage complications are rare and not readily predictable based on preprocedure arteriography.
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outcome after Celiac Artery coverage during endovascular thoracic aortic aneurysm repair preliminary results
Journal of Vascular Surgery, 2007Co-Authors: Sarat K Vaddineni, Steve M Taylor, Mark A Patterson, William D. JordanAbstract:Background Endovascular repair of descending thoracic aortic aneurysms has emerged as an alternative to open repair. Coverage of the left subclavian origin has been reported to expand the proximal sealing zone. We report the planned coverage of the Celiac Artery origin with a thoracic stent graft to achieve an adequate distal sealing zone. Methods All patients undergoing endovascular aneurysm repair are prospectively entered into a computerized database. All patients who underwent thoracic endovascular aneurysm repair with coverage of the Celiac Artery origin were identified and retrospectively analyzed. End points for evaluation included indications for covering the Celiac Artery, anatomic features of the distal landing zone, demonstration of collateral circulation between the Celiac Artery and the superior mesenteric Artery, technical success of the procedure, and presence of clinical ischemic symptoms after the procedure. Results Between March 2005 and May 2006, 46 patients underwent endovascular repair of descending thoracic aortic aneurysms. Seven patients had planned Celiac Artery coverage with a thoracic stent graft to secure an adequate distal sealing zone. Six patients demonstrated collateral circulation through the gastroduodenal Artery between the Celiac and superior mesenteric arteries before deployment of the stent graft. One patient had a distal type I endoleak at the conclusion of the procedure related to inadequate sealing at the superior mesenteric Artery origin. No type II endoleaks were evident at the final intraoperative angiogram or 30-day computed tomography scan. There were no postoperative deaths, no ischemic abdominal complications, and no clinical spinal cord ischemia. Short-term follow-up (1 to 10 months) has demonstrated no additional endoleaks (type I not fully assessed), no aneurysm growth, and no aneurysm ruptures. Conclusion This limited series supports the suitability, in selected patients, of covering the Celiac Artery origin for a distal landing zone when the distal sealing zone proximal to the Celiac Artery is inadequate. We recommend the angiographic evaluation of the collateral circulation between the Celiac and superior mesenteric arteries when covering the Celiac Artery origin is being considered.
Alex D. Ammar - One of the best experts on this subject based on the ideXlab platform.
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Spontaneous dissection of the Celiac Artery: A case report
Journal of vascular surgery, 2007Co-Authors: Jason D. Woolard, Alex D. AmmarAbstract:Spontaneous dissection of visceral arteries is rare in the absence of concurrent dissection of the aorta, iatrogenic injury from instrumentation, or trauma. We describe a spontaneous dissection of the Celiac Artery that was identified by computed tomographic scan in an otherwise healthy man with acute onset abdominal pain and no identifiable causes of dissection. The patient was successfully managed medically. Although endovascular treatment or surgical intervention is the procedure of choice for complicated cases, medical management with close observation is an acceptable management strategy for stable, uncomplicated cases of spontaneous Celiac Artery dissection.
John Hines - One of the best experts on this subject based on the ideXlab platform.
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Spontaneous isolated dissection of the Celiac Artery: CT findings in adults.
AJR. American journal of roentgenology, 2007Co-Authors: Nicholas D'ambrosio, Barak Friedman, David N. Siegel, Douglas S. Katz, Amit Newatia, John HinesAbstract:OBJECTIVE. Our objective was to describe the CT features of spontaneous isolated Celiac Artery dissection in a series of six otherwise healthy patients with acute abdominal pain.CONCLUSION. Although once believed rare, isolated spontaneous Celiac Artery dissection should be considered in the diagnosis of acute abdominal pain, especially in middle-aged adults.
Enrique Criado - One of the best experts on this subject based on the ideXlab platform.
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Isolated Celiac Artery dissection
Journal of vascular surgery, 2015Co-Authors: Paul D. Dimusto, Molly M. Oberdoerster, Enrique CriadoAbstract:Objective Spontaneous Celiac Artery dissection is rare, and its natural history is not well studied. The objective of this study was to review our experience with the evaluation and management of this condition. Methods During the last 8 years, 19 patients (14 men, five women) presented with the diagnosis of spontaneous Celiac Artery dissection. Each patient's clinical course was retrospectively reviewed, and patients were contacted for assessment of current symptoms. Results All patients had computed tomography scans documenting a Celiac Artery dissection without concomitant aortic dissection. Ages ranged from 39 to 76 years. Seven patients presented with abdominal pain, and 12 were diagnosed incidentally. All patients were initially treated with observation because none had threatened end organs. Patients presenting with aspirin or clopidogrel therapy were continued on these medications, but no patients were prescribed any medications due to their dissection. Three patients continued to have abdominal pain and eventually underwent Celiac Artery stenting. Pain improved after the intervention in all three. One patient with aneurysmal degeneration of the Celiac Artery underwent surgical repair. No other patients required intervention. Eighteen patients had follow-up within a year of data collection in the clinic or over the phone. The average time from the initial diagnosis to follow-up for the entire cohort was 46 months. None had abdominal or back pain related to the Celiac dissection, had lost weight, or had to change their eating habits. Conclusions Celiac Artery dissection can be safely managed initially with observation. If abdominal pain is persistent, endovascular stenting may stabilize or improve the pain, and surgical reconstruction can be done for aneurysmal degeneration or occlusion, both unusual events. Long-term anticoagulation does not appear necessary in these patients.