Outcomes of Intentional Celiac Artery Coverage During Thoracic Endovascular Aortic Repair for Infective Native Aortic Aneurysms: A Case Series

Intentional celiac artery (CA) coverage during thoracic endovascular aortic repair (TEVAR) may be required to achieve an adequate distal landing zone; however, this strategy remains controversial owing to concerns regarding visceral ischemia, particularly in patients with infective native aortic aneurysms with compromised physiology and hostile anatomy. We retrospectively reviewed three patients who underwent TEVAR with planned CA coverage after angiographic assessment of collateral circulation using balloon occlusion testing and selective superior mesenteric artery angiography, with CA embolization. All patients demonstrated robust collateral perfusion, underwent CA embolization, and subsequently TEVAR with intentional CA coverage. One patient developed a type Ib endoleak on surveillance imaging without sac expansion. No hepatic, gastric, or splenic ischemic events occurred during follow-up. This case series suggests that intentional CA coverage may be feasible in carefully selected patients when guided by meticulous collateral assessment, offering a pragmatic option in urgent or anatomically constrained settings.