Coverage of the Coeliac Artery During Thoracic Endovascular Aortic Repair: A Systematic Review and Meta-Analysis

Abstract

To investigate the clinical impact of coeliac artery (CA) coverage during thoracic endovascular aortic repair (TEVAR). This systematic review and meta-analysis was conducted according to the PRISMA guidelines. Electronic databases were searched from 1989 to 2020 for studies reporting visceral ischaemia, spinal cord ischaemia (SCI), 30 day/in hospital mortality, endoleaks, re-intervention, and caudal stent graft migration following CA coverage in patients undergoing TEVAR. Meta-analysis was conducted using random effects modelling. The quality of the evidence was graded using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Fifteen observational studies with 236 patients (108 male, age range 61.3 - 79 years) were included. The pooled visceral ischaemia rate was 13% with significant heterogeneity between studies (95% confidence intervals [CI] 4 - 24; I2= 72%, p < .001). The SCI rate was 5% (95% CI 2 - 9; I2= 0%); the 30 day/in hospital mortality was 4% (95% CI 1 - 7; I2= 0%); the overall endoleak rate was 21% (95% CI 13 - 29; I2= 35%) with a 5% (95% CI 0 - 13; I2= 38%) rate of type Ib and 2% (95% CI 0 - 8; I2= 43%) rate of type II endoleak from retrograde CA flow. The re-intervention rate was 13% (95% CI 6 - 22; I2= 54%); the caudal stent graft migration rate was 3% (95% CI 0 - 9, I2= 0%). The certainty of the body of evidence was judged to be very low for all outcomes. CA coverage during TEVAR is associated with high rates of visceral ischaemia, spinal cord ischaemia, 30 day/in hospital mortality, endoleaks, and re-intervention. Although the literature is of poor quality and questions remain over effects estimates, there is evidence that CA coverage should be avoided if at all possible, during TEVAR. PROSPERO registration number 244084.