Coeliac stenosis or occlusion with aneurysm of the collateral supply

Aneurysm of the gastroduodenal artery associated with stenosis of the superior mesenteric artery

A 68-year-old patient was hospitalized after the incidental discovery of an aneurysm of the gastroduodenal artery associated with stenosis of the superior mesenteric artery. This patient had severe heart failure, which led to acute pulmonary edema and inoperable triple-vessel coronary disease. In the first of two procedures the superior mesenteric artery was dilated; 48 hours later the gastroduodenal artery aneurysm was embolized with minicoils and acryl glue. Immediate and follow-up arteriograms at 10 months showed that results were satisfactory. Transluminal treatment of both lesions is an alternative to surgical treatment, especially in high-risk patients.

Pancreaticoduodenal artery aneurysms associated with celiac axis stenosis: report of two cases and review of the literature

We have endeavored to define the incidence of pancreaticoduodenal artery aneurysm associated with stenosis of the celiac axis and to address modalities in this setting. This association was found in 23 of 34 cases. Aneurysmal dilation of the pancreatic arteries associated with celiac axis stenosis is not accidental and seems to be due to increased flow through the peripancreatic arteries. Hemorrhagic complications, i.e., peripancreatic hematoma, hemoperitoneum, ductal hemorrhage, were the initial manifestation in 16 of 34 cases. Isolated aneurysms were treated by resection, exclusion or embolization without any complications. For associated aneurysms, resection and exclusion were employed. Pancreatoduodenectomy was required in three cases in which bleeding was uncontrollable. In six cases, the celiac axis was restored either by arterial reconstruction, aortohepatic bypass, or division of the arcuate ligament. Four patients died. All had been operated on for ruptured aneurysm. None of the deaths was directly due to ischemic compromise of the celiac artery bed. Because of the risk of rupture, all pancreaticoduodenal artery aneurysms should be treated surgically after appropriate investigation to detect associated celiac axis stenosis. Revascularization of the celiac axis is indicated whenever blood flow is reduced or, routinely, to reduce high peripancreatic collateral flow, particularly when collaterality is due to arcuate ligament-related stenosis.

Aneurysms of the pancreaticoduodenal arteries in association with celiac axis occlusion

Four patients with aneurysms of the inferior pancreaticoduodenal artery are described. All had occlusion of the celiac axis at its origin, with the inferior pancreaticoduodenal arcades serving as a collateral pathway. We propose that the association of the celiac axis occlusion and aneurysms in the collateral supply via the pancreatic arcades is more than coincidental. Awareness of this relationship may be of significance in planning therapeutic intervention.

Celiac artery obstruction after arteriography

The first case of celiac artery obstruction due to selective arteriography is reported. Impairment of flow to liver and duodenum was present; but the patient recovered uneventfully with non-operative treatment. Management of this problem centers around observation, liver support, and putting the gut at rest. If non-operative treatment is failing, operation should be done, vascular reconstruction carried out, and the duodenum inspected to ensure its viability.