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Sarad N, Basilious M, Nag U, Jethmalani N, Agrusa C, Ellozy S, DeRubertis B, Connolly P. Presentation and management of true aneurysms of the pancreaticoduodenal arcade with concomitant celiac artery stenosis using the endovascular approach. J Vasc Surg Cases Innov Tech 2024; 10:101499. [PMID: 38764461 PMCID: PMC11099304 DOI: 10.1016/j.jvscit.2024.101499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/21/2024] [Indexed: 05/21/2024] Open
Abstract
True aneurysms of the pancreaticoduodenal artery (PDA) arcade are rare but require intervention due to the high risk of rupture. Historically, these aneurysms have been managed with open surgical methods. In this study, we describe a contemporary series of aneurysms treated using a modern approach that includes endovascular and hybrid techniques. All the patients with aneurysms of the PDA arcade in an institutional database were identified between 2008 and 2022. Patients with history of pancreatic resection were excluded. Data on demographics, presenting symptoms, imaging findings, operative approach, and outcomes were collected and reviewed. There were nine patients diagnosed with a PDA aneurysm, and all nine underwent endovascular intervention. Most were men (n = 5; 55.6%) and White (n = 7; 77.8%) and had American Society of Anesthesiologists class II or III. The median aneurysm size was 21 mm (range, 6-42 mm), and five (55.5%) were symptomatic. Of the five symptomatic cases, two presented with rupture and were treated urgently. The median time to intervention for the nonurgent cases was 30 days. All but one patient had concomitant celiac artery stenosis and two of the eight cases (25%) were due to extrinsic compression from median arcuate ligament syndrome. Both patients underwent median arcuate ligament syndrome release before endovascular intervention. Another patient required open surgical bypass before endovascular repair from the supraceliac aorta to hepatic artery using a Dacron graft to maintain hepatic perfusion. Among the eight patients with celiac axis stenosis, five (62.5%) required celiac stent placement within the same operation. Coil embolization of the aneurysm was used for all except for two patients (n = 7 of 9; 77.8%), with one patient receiving embolic plugs and another receiving an 8 × 38-mm balloon-expandable covered stent for aneurysm exclusion. The median operating room time was 134 minutes. All repairs were technically successful without any intraoperative or postoperative complications. The mean follow-up was 30 months. There was no morbidity, mortality, or unplanned secondary reinterventions within 6 months after aneurysm repair. Stent patency and aneurysm size remained stable at 2 years of follow-up. True pancreaticoduodenal artery arcade aneurysms can be safely and effectively treated using endovascular and hybrid techniques. Because many of these aneurysms have concomitant celiac artery stenosis, the use of endovascular technology allows for simultaneous treatment of both the aneurysm and the stenosis with exceptional results.
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Affiliation(s)
- Nakia Sarad
- Division of Vascular and Endovascular Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, NY
| | - Mark Basilious
- Division of Vascular and Endovascular Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, NY
| | - Uttara Nag
- Division of Vascular and Endovascular Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, NY
| | - Nitin Jethmalani
- Division of Vascular and Endovascular Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, NY
| | - Christopher Agrusa
- Division of Vascular and Endovascular Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, NY
| | - Sharif Ellozy
- Division of Vascular and Endovascular Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, NY
| | - Brian DeRubertis
- Division of Vascular and Endovascular Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, NY
| | - Peter Connolly
- Division of Vascular and Endovascular Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, NY
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Karanasios E, Ragab Z, Cavenagh H, Stather P, Ali T. Characteristics and Trends in Median Arcuate Ligament Syndrome (MALS) Associated Visceral Artery Aneurysms: A Systematic Descriptive Review of the Literature. Vasc Endovascular Surg 2024; 58:512-522. [PMID: 38271562 DOI: 10.1177/15385744241229842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Introduction: Median Arcuate Ligament Syndrome (MALS) is associated with true aneurysms, mainly of both the pancreaticoduodenal artery (PDA) and gastroduodenal artery (GDA). Although rare, their potential for rupture and adverse clinical outcomes warrants analysis. Prior studies suggest high rupture rates even for smaller aneurysms under 2 cm in this setting. We performed a systematic literature review, synthesising the evidence on visceral artery aneurysms related to MAL syndrome, with a focus on descriptive analyses of aneurysm size, presentation, rupture rates, and management. Methods: Literature search was performed using (Medline, EMBASE, Emcare and CINAHL). Inclusion criteria included true aneurysms secondary to MALS with or without rupture. The cases with pseudoaneurysms, concomitant pathologies eg, pancreatitis, conservatively managed aneurysms and articles with non-granular pooled data were excluded. Cases were assessed according to demographics, clinical presentation, aneurysm diameter, aneurysm rupture and management technique. Results: 39 articles describing 72 patients were identified. Aneurysm diameter in symptomatic patients was not significantly different from asymptomatic patients {21.0 and 22.3 mm respectively, P = .84}. Ruptured aneurysms were overall smaller than non-ruptured at presentation {12.3 mm v 30.8 mm respectively, P = .02}. Patients presented with abdominal pain (75.6%), nausea/vomiting (15.6%), hypotension (33.9%), shock (20.0%) and haemodynamic collapse (8.9%). 56.9% of all cases were managed with an endovascular approach, 19.4% were managed with an open surgical approach, and 23.6% were managed hybrid. Conclusion: This review suggests visceral artery aneurysms associated with median arcuate ligament rupture at variable sizes. Despite inability to clearly correlate size and rupture risk, our data supports prompt intervention irrespective of size, given the adverse outcomes. Further research is critically needed to clarify size thresholds or other predictors to guide management.
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Affiliation(s)
| | - Zeyad Ragab
- Speciality Registrar- Radiology, Norfolk and Norwich University Hospitals, Norwich, UK
| | - Harry Cavenagh
- Speciality Registrar- Radiology, Norfolk and Norwich University Hospitals, Norwich, UK
| | - Philip Stather
- Consultant Vascular Surgeon, Norfolk and Norwich University Hospitals, Norwich, UK
| | - Tariq Ali
- Consultant Interventional Radiologist, Norfolk and Norwich University Hospitals, Norwich, UK
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Chidambaram R, Soares J, Hicks R, Samuelson S, Tibballs J, Ferguson J, Jansen S. Sutton-Kadir Syndrome can be treated safely with endovascular embolisation alone. J Med Imaging Radiat Oncol 2024; 68:289-296. [PMID: 38437188 DOI: 10.1111/1754-9485.13631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/21/2024] [Indexed: 03/06/2024]
Abstract
INTRODUCTION Sutton-Kadir Syndrome (SKS) describes true inferior pancreaticoduodenal artery (IPDA) aneurysms in the setting of coeliac artery (CA) stenosis or occlusion. Although rare, SKS aneurysms can rupture and cause morbidity. Due to its rarity and lack of controlled treatment data, correct treatment for the CA lesion is currently unknown. Our aim was to assess if endovascular embolisation alone was safe and effective in treatment of SKS aneurysms, in emergent and elective settings. Secondary objectives were to describe presentation and imaging findings. METHODS A retrospective cohort study of patients treated at Sir Charles Gairdner Hospital between January 2014 and December 2021 was done. Data on presentation, diagnostics, aneurysm characteristics, CA lesion aetiology, treatment and outcomes were extracted from chart review. RESULTS Twenty-four aneurysms in 14 patients were identified. Rupture was seen in 7/15 patients. Most aneurysms (22/24) were in the IPDA or one of its anterior or posterior branches. Median arcuate ligament (MAL) compression was identified in all. There was no difference in median (IQR) maximal transverse diameter between ruptured and non-ruptured aneurysms (6 mm (9), 12 mm (6), P = 0.18). Of ruptures, 6/7 had successful endovascular embolisation and 1/7 open surgical ligation. Of non-ruptures, 6/7 had successful endovascular embolisation, 1/7 open MAL division then endovascular CA stenting and aneurysm embolisation. No recurrences or new aneurysms were detected with computed tomography or magnetic resonance angiography over a median (IQR) follow-up period of 30 (10) months in 12 patients. CONCLUSION Endovascular embolisation of SKS aneurysms without treatment of MAL compression is safe and effective in both the emergent and elective settings.
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Affiliation(s)
- Rama Chidambaram
- Department of Vascular and Endovascular Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Julian Soares
- Department of Radiology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Rhiannon Hicks
- Department of Vascular and Endovascular Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Shaun Samuelson
- Department of Radiology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Jonathan Tibballs
- Department of Radiology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - John Ferguson
- Department of Radiology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Shirley Jansen
- Department of Vascular and Endovascular Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
- Heart and Vascular Research Institute, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
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Ghoneim B, Nash C, Akmenkalne L, Cremen S, Canning C, Colgan MP, O'Neill S, Martin Z, Madhavan P, O'Callaghan A. Staged treatment for pancreaticoduodenal artery aneurysm with coeliac artery revascularisation: Case report and systematic review. Vascular 2024; 32:162-178. [PMID: 36071691 DOI: 10.1177/17085381221124991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite being rare, pancreaticoduodenal artery aneurysms (PDAAs) carry a risk of rupture of up to 50% and are frequently associated with coeliac artery occlusion. METHODS PubMed and Embase databases were searched using appropriate terms. The systematic review was conducted according to PRISMA guidelines. RESULTS We present the case of a 2 cm pancreaticoduodenal artery aneurysm pre-operative angiography demonstrated that the coeliac artery was occluded and the pancreaticoduodenal artery was providing collateral blood supply to the liver. Treatment was a staged hybrid intervention inclusive of an aorto-hepatic bypass using a 6 mm graft, followed by coil embolisation of the aneurysm. We also present a systematic review of the management of PDAAs. Two hundred and ninety-two publications were identified initially with 81 publications included in the final review. Of the 258 peripancreatic aneurysms included, 175 (61%) were associated with coeliac artery disease either occlusion or stenosis. Abdominal pain was the main presentation in 158 cases. Rupture occurred in 111 (40%) of patients with only ten (3.8%) cases being unstable on presentation. Fifty (18%) cases were detected incidentally while investigating another pathology. Over half the cases (n=141/54.6%) were treated by trans arterial embolisation (TAE) alone, while 37 cases had open surgery only. Twenty-one cases needed TAE and a coeliac stent. Seventeen cases underwent hybrid treatment (open and endovascular). Sixteen cases were treated conservatively and in 26 cases, treatment was not specified. CONCLUSION PDAAs are commonly associated with coeliac artery disease. The most common presentation is pain followed by rupture. The scarcity of literature about true peripancreatic artery aneurysms associated with CA occlusive disease makes it difficult to assess the natural history or the appropriate treatment. Revascularisation of hepatic artery is better done with bypass in setting of median arcuate ligament compression and occluded celiac trunk.
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Affiliation(s)
- Baker Ghoneim
- Department of Vascular Surgery, St James Hospital, Dublin, Ireland
| | - Connor Nash
- Department of Vascular Surgery, St James Hospital, Dublin, Ireland
| | - Liga Akmenkalne
- Department of Vascular Surgery, St James Hospital, Dublin, Ireland
| | - Sinead Cremen
- Department of Vascular Surgery, St James Hospital, Dublin, Ireland
| | - Catriona Canning
- Department of Vascular Surgery, St James Hospital, Dublin, Ireland
| | - Mary P Colgan
- Department of Vascular Surgery, St James Hospital, Dublin, Ireland
| | - Sean O'Neill
- Department of Vascular Surgery, St James Hospital, Dublin, Ireland
| | - Zenia Martin
- Department of Vascular Surgery, St James Hospital, Dublin, Ireland
| | - Prakash Madhavan
- Department of Vascular Surgery, St James Hospital, Dublin, Ireland
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Siauve V, Chevallier O, Mazit A, Falvo N, Comby PO, Loffroy R. Interventional Radiology for High-Flow Aneurysm of the Pancreaticoduodenal Arcades with Median Arcuate Ligament Syndrome: Review of 14 Patients. J Clin Med 2023; 12:4692. [PMID: 37510806 PMCID: PMC10381139 DOI: 10.3390/jcm12144692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/07/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
Transarterial embolization (TAE) for high-flow pancreaticoduodenal artery (PDA) aneurysms in patients with celiac-trunk stenosis by the median arcuate ligament (MAL) has been found effective both after rupturing and to prevent rupture. The objective was to describe the TAE techniques used and their effectiveness in excluding PDA aneurysms due to MAL syndrome. This single-center retrospective study done at the Dijon-Bourgogne University Hospital included all patients treated by TAE in 2010-2022 for ruptured or unruptured high-flow PDA aneurysms caused by MAL syndrome. We identified 14 patients (7 women and 7 men; mean age, 64 years). Packing and trapping techniques were used alone or together. Occlusion was with microcoils, co-polymer, or cyanoacrylate glue, used separately or combined. Technical success was achieved in 13 (93%) patients. Clinical success was achieved in 12 (86%) patients. One major and two minor complications were recorded within the first 30 days. No complications occurred after 30 days. Follow-up ranged from 1 to 84 months. No cases of aneurysm recanalization have been recorded to date. TAE had high technical and clinical success rates in our patients with unruptured or ruptured PDA aneurysms due to MAL syndrome.
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Affiliation(s)
- Valentin Siauve
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France
| | - Olivier Chevallier
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France
- ICMUB Labboratory, UMR CNRS 6302, University of Burgundy, 9 Avenue Alain Savary, 21000 Dijon, France
| | - Amin Mazit
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France
| | - Nicolas Falvo
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France
- ICMUB Labboratory, UMR CNRS 6302, University of Burgundy, 9 Avenue Alain Savary, 21000 Dijon, France
| | - Pierre-Olivier Comby
- ICMUB Labboratory, UMR CNRS 6302, University of Burgundy, 9 Avenue Alain Savary, 21000 Dijon, France
- Department of Neuroradiology and Emergency Radiology, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France
| | - Romaric Loffroy
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France
- ICMUB Labboratory, UMR CNRS 6302, University of Burgundy, 9 Avenue Alain Savary, 21000 Dijon, France
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Transarterial Embolization of Ruptured Pancreaticoduodenal Artery Pseudoaneurysm Related to Chronic Pancreatitis. Diagnostics (Basel) 2023; 13:diagnostics13061090. [PMID: 36980398 PMCID: PMC10047043 DOI: 10.3390/diagnostics13061090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 03/16/2023] Open
Abstract
We presented a 67-year-old woman with lightheadedness, diaphoresis, and acute epigastric and right hypochondrium pain, with a past medical history including stage 2 essential hypertension, chronic ischemic cardiomyopathy, and class 1 obesity. An abdominal contrast-enhanced CT scan showed an extensive hematoma (3 × 4 cm2 in size) located intra-abdominally, adjacent to the duodenojejunal area, with hyperdensity around the duodenum, positioned inferior to the pancreas (30–59 HU). Moreover, the CT scan also revealed an enhancing lesion as a pseudoaneurysm of the inferior pancreaticoduodenal artery, measuring 5 × 8 × 8 mm3 with active bleeding and associated hematoma. Following these investigations of the abdominal area, a decision was made to proceed with an endovascular intervention within the interventional radiology department. With the patient under conscious sedation, via a right common femoral artery approach, the superior mesenteric artery was catheterized. While injecting the contrast agent to obtain a better working projection, the pseudoaneurysm ruptured, and acute extravasation of the contrast agent was noted, followed by injection of a mixture of 1 mL Glubran 2 with 2 mL Lipiodol until complete obliteration of the pseudoaneurysm was obtained. The patient was hemodynamically stable at the end of the procedure and was discharged 6 days later in a good condition without active bleeding signs.
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Cui J, Liu Y, Li J. Gastrointestinal bleeding caused by rupture of a posterior inferior pancreaticoduodenal artery pseudoaneurysm: A case report. Medicine (Baltimore) 2022; 101:e32123. [PMID: 36482622 PMCID: PMC9726413 DOI: 10.1097/md.0000000000032123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Gastrointestinal bleeding caused by a ruptured pancreatic pseudoaneurysm is rare, and a pseudoaneurysm of the posterior inferior pancreaticoduodenal artery is especially rare. A 68-year-old man was hospitalized after presenting intermittent black stools and dyspnea accompanied by severe anemia. Angiographic examination revealed that Pseudoaneurysm of the posterior inferior pancreaticoduodenal artery. METHODS Angiography was performed and revealed a pseudoaneurysm of the posterior inferior pancreaticoduodenal artery. Subsequently, a blood transfusion and endovascular embolization were performed. RESULTS The patient's gastrointestinal bleeding stopped, and the hemoglobin level remained stable. During 1 year of follow-up, the patient remained in a generally good condition. CONCLUSION posterior inferior pancreaticoduodenal artery pseudoaneurysmIt is rare and difficult to diagnose, gastrointestinal bleeding is a serious complication, vascular interventional embolization is effective.
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Affiliation(s)
- JinHua Cui
- Department of Hepatobiliary Surgery, Affiliated Hospital of Chengde Medical College, Chengde City, Hebei Province, China
| | - YaMan Liu
- Department of Gynaecology, Affiliated Hospital of Chengde Medical College, Chengde City, Hebei Province, China
| | - Jian Li
- Department of Hepatobiliary Surgery, Affiliated Hospital of Chengde Medical College, Chengde City, Hebei Province, China
- * Correspondence: Jian Li, Department of Hepatobiliary Surgery, Affiliated Hospital of Chengde Medical College, No. 36, Nanyingzi Street, Chengde City, Hebei Province 067000, China (e-mail: )
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8
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Onishi Y, Shimizu H, Isoda H, Shinozuka K, Ohtsuru S, Nakamoto Y. Transcatheter arterial embolization for bleeding from the pancreaticoduodenal artery in patients with celiac artery stenosis: A technical report. Acta Radiol Open 2022; 11:20584601221135180. [PMID: 36313861 PMCID: PMC9597204 DOI: 10.1177/20584601221135180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/09/2022] [Indexed: 11/12/2022] Open
Abstract
Background Transcatheter arterial embolization (TAE) is widely accepted as a treatment for bleeding from the pancreaticodoudenal artery (PDA) in patients with celiac artery stenosis. However, the technical aspect of TAE has not received much attention. Purpose To report the technical details and success rate of TAE for bleeding from the PDA in patients with CA stenosis. Material and Methods Between 2015 and 2021, nine TAE procedures were performed in eight patients (five women, three men; one woman underwent TAE twice). The cause of CA stenosis was compression by the median arcuate ligament in eight cases and CA dissection in one case. The cause of bleeding was flow-related aneurysm rupture in six cases. Pre-TAE CT showed a pseudoaneurysm in all cases. The technical details of TAE were recorded, and the success rate was evaluated. Results The technical and clinical success rates were 100%. In six cases, both the CA and superior mesenteric artery (SMA) were cannulated using two parent catheters: a microcatheter advancing to the pseudoaneurysm from the CA (the CA approach) to achieve embolization and another catheter for angiography advancing from the SMA to map the vascular anatomy. In five cases, the CA approach was successfully performed after failed attempts of advancing a microcatheter from the SMA. Conclusion TAE is an effective treatment for bleeding from the PDA in patients with CA stenosis. Using two parent catheters, one for CA cannulation and microcatheter advancement and another for SMA cannulation and vascular mapping, may be a useful technique.
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Affiliation(s)
- Yasuyuki Onishi
- Department of Diagnostic Imaging
and Nuclear Medicine, Graduate School of Medicine,
Kyoto
University, Kyoto, Japan,Yasuyuki Onishi, MD, Department of
Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto
University, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Hironori Shimizu
- Department of Diagnostic Imaging
and Nuclear Medicine, Graduate School of Medicine,
Kyoto
University, Kyoto, Japan
| | - Hiroyoshi Isoda
- Department of Diagnostic Imaging
and Nuclear Medicine, Graduate School of Medicine,
Kyoto
University, Kyoto, Japan
| | - Ken Shinozuka
- Department of Primary Care and
Emergency Medicine, Graduate School of Medicine,
Kyoto
University, Kyoto, Japan
| | - Shigeru Ohtsuru
- Department of Primary Care and
Emergency Medicine, Graduate School of Medicine,
Kyoto
University, Kyoto, Japan
| | - Yuji Nakamoto
- Department of Diagnostic Imaging
and Nuclear Medicine, Graduate School of Medicine,
Kyoto
University, Kyoto, Japan
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Negmadjanov U, Motta JC, De Grandis E, Lee WA. A Hybrid Approach in the Management of a Large Pancreaticoduodenal Artery Aneurysm. Ann Vasc Surg 2021; 79:441.e1-441.e5. [PMID: 34653641 DOI: 10.1016/j.avsg.2021.07.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 11/01/2022]
Abstract
Pancreaticoduodenal artery aneurysms (PDAA) are rare and represent a small fraction of known visceral aneurysms. We describe a case of a 79-year-old male with an 82 mm PDAA in the setting of chronic celiac artery occlusion. The patient was treated with an open repair. Due to the large size of the aneurysm and the dense adhesions to the surrounding tissues, vascular control of the superior mesenteric artery (SMA) was achieved by endovascular balloon occlusion and the aneurysm repaired with resection and primary aneurysmorrhaphy. The patient had an uneventful postoperative course.
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Affiliation(s)
- Ulugbek Negmadjanov
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL
| | - John C Motta
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL
| | - Eileen De Grandis
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL
| | - W Anthony Lee
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL.
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10
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Parfenov IP, Shubin AA, Vardanyan AV, Dolidze DD, Kovantsev SD. [Surgical treatment of pancreaticoduodenal artery aneurysm combined with celiac trunk occlusion]. Khirurgiia (Mosk) 2021:64-69. [PMID: 33759471 DOI: 10.17116/hirurgia202104164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report successful surgical treatment of inferior pancreaticoduodenal artery aneurysm combined with celiac trunk occlusion. Considering angioarchitectonics of the afferent and efferent arteries (significant tortuosity), possible liver ischemia during endovascular occlusion of pancreaticoduodenal artery and expected low efficiency of embolization, the patient underwent open surgery (celiac trunk replacement and resection of pancreaticoduodenal artery aneurysm). Postoperative period was uneventful. The first and subsequent postoperative controls showed an adequate function of the prosthesis and no contrast enhancement of the aneurysm. We concluded that rational surgical approach ensured optimal solution of the problem, i.e. surgical treatment of pancreaticoduodenal artery aneurysm was the most radical and functional.
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Affiliation(s)
- I P Parfenov
- Russian Medical Academy for Continuous Professional Education, Moscow, Russia
| | - A A Shubin
- Botkin City Clinical Hospital, Moscow, Russia
| | - A V Vardanyan
- Botkin City Clinical Hospital, Moscow, Russia.,Russian Medical Academy for Continuous Professional Education, Moscow, Russia
| | - D D Dolidze
- Botkin City Clinical Hospital, Moscow, Russia.,Russian Medical Academy for Continuous Professional Education, Moscow, Russia
| | - S D Kovantsev
- Russian Medical Academy for Continuous Professional Education, Moscow, Russia
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11
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Mochida Y, Miyakuni Y, Kaita Y, Yamaguchi Y. Resuscitative endovascular balloon occlusion of the aorta for ruptured pancreaticoduodenal artery aneurysm. Clin Case Rep 2021; 9:686-688. [PMID: 33598226 PMCID: PMC7869346 DOI: 10.1002/ccr3.3618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/27/2020] [Accepted: 11/13/2020] [Indexed: 11/27/2022] Open
Abstract
Resuscitative endovascular balloon occlusion of the aorta is useful as a troubleshooting response to hemorrhage and a temporary method for maintaining patient hemodynamics.
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Affiliation(s)
- Yuki Mochida
- Department of Trauma and Critical Care MedicineKyorin University School of MedicineTokyoJapan
| | - Yasuhiko Miyakuni
- Department of Trauma and Critical Care MedicineKyorin University School of MedicineTokyoJapan
| | - Yasuhiko Kaita
- Department of Trauma and Critical Care MedicineKyorin University School of MedicineTokyoJapan
| | - Yoshihiro Yamaguchi
- Department of Trauma and Critical Care MedicineKyorin University School of MedicineTokyoJapan
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12
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Natural History of Unruptured Visceral Artery Aneurysms Due to Segmental Arterial Mediolysis and Efficacy of Transcatheter Arterial Embolization: A Retrospective Multiinstitutional Study in Japan. AJR Am J Roentgenol 2021; 216:691-697. [PMID: 33439045 DOI: 10.2214/ajr.19.22547] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this study was to clarify the natural history of unruptured visceral artery aneurysms due to segmental arterial mediolysis and the efficacy of transcatheter arterial embolization. MATERIALS AND METHODS. Patients with a pathologic or clinical diagnosis of visceral artery aneurysms due to segmental arterial mediolysis between 2005 and 2015 were enrolled. For patients with clinical diagnoses, images were collected and assessed by central radiologic review. To clarify the natural history of unruptured aneurysms, the morphologic changes were assessed. The efficacy and safety of transcatheter arterial embolization for aneurysms due to segmental arterial mediolysis were evaluated. RESULTS. Forty-five patients with 123 aneurysms due to segmental arterial mediolysis were enrolled. Among the 123 aneurysms, 70 unruptured aneurysms were evaluated for natural history. Forty-five of the 70 (64%) aneurysms had no change in morphology. Among the other 25 aneurysms, nine (13% of the 70) were reduced in size, 13 (19%) disappeared, and three (4%) were newly found at follow-up. Aneurysms of the middle colic artery were ruptured in 10 of 11 (91%) cases. Transcatheter arterial embolization was performed on 45 aneurysms and was successful in all cases but caused slight arterial injury in three cases (6.7%). CONCLUSION. At initial diagnosis, unruptured aneurysms due to segmental arterial mediolysis are likely to be stable or to resolve, but the risk of rupture of aneurysms of the middle colic artery appears high. Transcatheter arterial embolization is a useful treatment, but careful manipulation is necessary.
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Ohta K, Shimohira M, Shoji J, Yoshida S, Takaishi T, Morimoto M, Matsuo Y, Ogawa T, Suda H, Shibamoto Y. Multiple large pancreaticoduodenal artery aneurysms due to celiac artery occlusion: Combination of the aorto-hepatic bypass and coil embolization with a dual approach through both the superior mesenteric artery and bypass. Radiol Case Rep 2020; 16:1-4. [PMID: 33144901 PMCID: PMC7596011 DOI: 10.1016/j.radcr.2020.10.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 10/12/2020] [Accepted: 10/17/2020] [Indexed: 11/28/2022] Open
Abstract
Pancreaticoduodenal artery aneurysm can occur from occlusion or stenosis of the celiac artery due to arteriosclerosis or median arcuate ligament compression. The risk of rupture of the aneurysm is independent of the aneurysmal diameter. A 78-year-old woman presented with multiple large aneurysms of the anterior superior pancreaticoduodenal artery. To preserve arterial flow to the liver, bypass grafting from the supra-celiac aorta to the common hepatic artery was performed at first. Coil embolization was successfully performed 10 days later with a dual approach through both the superior mesenteric artery and bypass. It was considered that the combination of the aorto-hepatic bypass and coil embolization was effective for the pancreaticoduodenal artery aneurysms due to celiac artery occlusion.
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Affiliation(s)
- Kengo Ohta
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Masashi Shimohira
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Jumpei Shoji
- Department of Radiology, Japanese Red Cross Nagoya Daini Hospital, Nagoya 466-8650, Japan
| | - Shiro Yoshida
- Department of Radiology, Nishichita General Hospital, Tokai 477-8522, Japan
| | - Taku Takaishi
- Department of Radiology, Konan Kosei Hospital, Konan 483-8704, Japan
| | - Mamoru Morimoto
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Science, Nagoya 467-8601, Japan
| | - Yoichi Matsuo
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Science, Nagoya 467-8601, Japan
| | - Tatsuhito Ogawa
- Department of Cardiovascular Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Hisao Suda
- Department of Cardiovascular Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
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Imam R, Khalayleh H, Khoury D, Lin G, Imam A. Rupture of an Idiopathic Aneurysm of the Inferior Pancreaticoduodenal Artery Leading to an Intra-Abdominal Bleeding. JOURNAL OF ACUTE CARE SURGERY 2020. [DOI: 10.17479/jacs.2020.10.1.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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15
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Inoue A, Ohta S, Imai Y, Murakami Y, Tomozawa Y, Sonoda A, Nitta N. Naturally shrunk visceral artery aneurysms by stenting for the superior mesenteric artery occlusion. MINIM INVASIV THER 2020; 30:245-249. [PMID: 32100596 DOI: 10.1080/13645706.2020.1732426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A 77-year-old woman who had experienced postprandial abdominal pain for four years was admitted to our institution presenting sudden and severe abdominal pain. Contrast-enhanced computed tomography (CECT) demonstrated complete short-segmented occlusion in the orifice of the superior mesenteric artery (SMA), and saccular aneurysms in the right hepatic artery and the anterior superior pancreaticoduodenal artery. She was diagnosed with abdominal angina due to occlusion of the SMA. The SMA was recanalized by stenting, and a CECT scan confirmed naturally shrunk aneurysms after eight months. The patency of the SMA was maintained at five years after endovascular treatment.
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Affiliation(s)
- Akitoshi Inoue
- Department of Radiology, Shiga University of Medical Science, Shiga, Japan
| | - Shinichi Ohta
- Department of Radiology, Shiga University of Medical Science, Shiga, Japan
| | - Yugo Imai
- Department of Radiology, Shiga University of Medical Science, Shiga, Japan
| | - Yoko Murakami
- Department of Radiology, Shiga University of Medical Science, Shiga, Japan
| | - Yuki Tomozawa
- Department of Radiology, Shiga University of Medical Science, Shiga, Japan
| | - Akinaga Sonoda
- Department of Radiology, Shiga University of Medical Science, Shiga, Japan
| | - Norihisa Nitta
- Department of Radiology, Shiga University of Medical Science, Shiga, Japan
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Imagami T, Takayama S, Hattori T, Matsui R, Kani H, Tanaka A, Ando M, Kodani N. Transarterial Embolization With Complementary Surgical Ligation of Gastroduodenal Artery for Ruptured Pancreaticoduodenal Artery Aneurysm. Vasc Endovascular Surg 2019; 53:593-598. [PMID: 31248357 DOI: 10.1177/1538574419859693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The association between pancreaticoduodenal artery aneurysm (PDAA) and local hemodynamic changes in pancreaticoduodenal arcades is well established. However, there are few case reports of PDAA associated with acute aortic dissection. In this article, we outline and discuss the case of a 61-year-old man diagnosed with a type A acute aortic dissection who underwent emergency surgery and developed sudden-onset severe abdominal pain and shock 10 days later. Contrast-enhanced computed tomography showed a ruptured PDAA with feeding vessels from the gastroduodenal and superior mesenteric arteries, with evidence that the celiac artery was diverged from a false lumen. Transarterial embolization via the superior mesenteric artery alone was not expected to achieve hemostasis, so we performed a hybrid procedure involving transarterial embolization cannulated from superior mesenteric artery with complementary surgical ligation of the gastroduodenal artery. The postoperative course was uneventful, and follow-up contrast-enhanced computed tomography showed no persistence of the aneurysm 8 days after the second operation. This case proposed that visceral arterial malperfusion due to acute aortic dissection can cause PDAA in the early postoperative period. Although previous reports suggest that endovascular treatment is preferable, it may not always be feasible. Since ruptured PDAAs are often not detected during surgery, surgical treatment can be overly invasive. Whereas, transarterial embolization with complementary clamping or ligation of the gastroduodenal artery for ruptured PDAA is less invasive and can control hemorrhage, especially when cannulation to the celiac artery is impossible. Notably, the technique did not cause organ ischemia, presumably because the small collateral vessels of the pancreaticoduodenal arcades permitted sufficient blood flow. If endovascular treatment is unable to achieve rapid hemostasis, this technique may be a useful option for ruptured PDAA.
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Affiliation(s)
- Toru Imagami
- 1 Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai City, Japan
| | - Satoru Takayama
- 1 Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai City, Japan
| | - Taku Hattori
- 1 Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai City, Japan
| | - Ryohei Matsui
- 1 Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai City, Japan
| | - Hisanori Kani
- 1 Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai City, Japan
| | - Akimitsu Tanaka
- 2 Department of Cardiology of Heart Center, Nagoya Tokushukai General Hospital, Kasugai City, Japan
| | - Miyuki Ando
- 2 Department of Cardiology of Heart Center, Nagoya Tokushukai General Hospital, Kasugai City, Japan
| | - Noriko Kodani
- 3 Department of Cardiovascular Surgery, Nagoya Tokushukai General Hospital, Kasugai City, Japan
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Kuruma S, Kikuyama M, Kamisawa T, Chiba K. Hyper-dense fluid on plain computed tomography may reveal a ruptured aneurysm in patients with median arcuate ligament syndrome. Clin J Gastroenterol 2019; 12:473-478. [PMID: 30997671 DOI: 10.1007/s12328-019-00968-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 03/16/2019] [Indexed: 11/26/2022]
Abstract
Rupture of abdominal aneurysms associated with median arcuate ligament syndrome (MALS) is a serious condition and requires accurate diagnosis in a clinical setting. We examined three patients with this condition: two women aged 45 and 71 years, and a 61-year-old man. They complained of abdominal pain and had fluid collection around the duodenum. Plain computed tomography (CT) of the fluid collection revealed hyper density, which suggests the presence of blood. Moreover, contrast-enhanced CT revealed aneurysms in the pancreatic head area. Angiography revealed aneurysms of the branches of the gastroepiploic artery, which were treated by endovascular embolization in all patients. Thus, patients with abdominal pain and high-density fluid collection around the duodenum on plain CT may suffer from hemorrhage following rupture of MALS-associated aneurysms.
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Affiliation(s)
- Sawako Kuruma
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan.
| | - Masataka Kikuyama
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Terumi Kamisawa
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Kazuro Chiba
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
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Pseudoaneurysm of the Inferior Pancreaticoduodenal Artery Due to Cholecystitis. REPORTS 2019. [DOI: 10.3390/reports2010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Inferior pancreaticoduodenal artery pseudoaneurysms and aneurysms are a rare occurrence, comprising of approximately 10% of visceral artery aneurysms and pseudoaneurysms. The cause is normally due to trauma, iatrogenic or pancreatitis. We present a case of a patient re-presenting to hospital following treatment of acute cholecystitis with epigastric pain, dysphagia, pyrexia, nausea, vomiting and an acute kidney injury. Following cholecystostomy, intravenous fluids and conservative treatment for her symptoms, she failed to improve significantly and was found to have a 6 mm pseudoaneurysm of the inferior pancreaticoduodenal artery on day twenty of her admission. She was transferred to a tertiary centre and was treated with an embolisation and recovered well from the procedure.
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Zhang X, Zhang W, Zhou W, Zhou W. Endovascular Treatment of Ruptured Pancreaticoduodenal Artery Aneurysm with Celiac Axis Stenosis. Ann Vasc Surg 2019; 57:273.e1-273.e5. [PMID: 30684620 DOI: 10.1016/j.avsg.2018.09.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 09/06/2018] [Accepted: 09/28/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Splanchnic artery aneurysms are relatively rare diseases. Pancreaticoduodenal arterial (PDA) aneurysms are especially uncommon and account for approximately 2% of all visceral aneurysms. However, rupture of a PDA aneurysm often results in fatal consequences. Intervention therapy has evolved as a mainstream method because of its low risk and rapid recovery. Previous studies have demonstrated that PDA aneurysms are often associated with occlusion or stenosis of the celiac artery, but management of the celiac artery lesion remains controversial. Here, we report a case of PDA aneurysm concurrent with celiac axis stenosis (CAS) that has been successfully treated by embolization of the PDA aneurysm and subsequent stenting of the celiac artery. CASE PRESENTATION A 50-year-old man complaining of epigastric pain for 15 hours was admitted to our emergency department. Blood tests revealed low hemoglobin, and an abdominal computed tomography (CT) showed a retroperitoneal hematoma. To determine the source of bleeding, celiac arteriography was performed immediately. Celiac truck stenosis was observed, and a PDA ruptured aneurysm was diagnosed. The outflow, aneurysm sac, and inflow of the aneurysm were embolized. The patient was discharged on the sixth day postoperatively. Unfortunately, the patient returned to our department 2 weeks later complaining of nausea and vomiting for 2 days. The abdominal CT scan showed no recurrent bleeding. Celiac artery stenting was performed, and the symptoms were significantly relieved. The postoperative course was uneventful, and the CT scan follow-up at 24 months showed patency of the celiac artery stent and total occlusion of the PDA. CONCLUSIONS PDA aneurysms associated with celiac stenosis are relatively rare. Once the PDA aneurysm ruptures, endovascular treatment is the first choice. The necessity for revascularization of the celiac axis remains controversial. If the patient develops gastric ischemia symptoms after initial treatment, proceeding to CAS treatment is necessary.
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Affiliation(s)
- Xiaoyu Zhang
- Department of Vascular Surgery, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Wenwen Zhang
- Department of Vascular Surgery, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Weimin Zhou
- Department of Vascular Surgery, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
| | - Wei Zhou
- Department of Vascular Surgery, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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Heo S, Kim HJ, Kim B, Lee JH, Kim J, Kim JK. Clinical impact of collateral circulation in patients with median arcuate ligament syndrome. ACTA ACUST UNITED AC 2018; 24:181-186. [PMID: 30091707 DOI: 10.5152/dir.2018.17514] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE We aimed to analyze computed tomography (CT) findings and medical records of patients diagnosed with median arcuate ligament syndrome (MALS) and evaluate possible risk factors associated with vascular complications that develop in patients with MALS. METHODS This retrospective study was approved by the institutional review board, and the requirement to obtain informed consent was waived. A total of 37 consecutive patients were diagnosed with MALS using both axial and sagittal CT reconstruction imaging at a single institution over a 7-year period. Dynamic contrast-enhanced CT data, medical records, and angiography results were reviewed. RESULTS Thirty-two (86.5%) patients were asymptomatic and incidentally diagnosed with MALS using CT. Seventeen (45.9%) patients exhibited significant arterial collateral circulations and nine (24.3%) were found to have splanchnic artery aneurysms, including one (2.7%) with acute bleeding secondary to aneurysm rupture. Peripancreatic vascular network including pancreaticoduodenal arcades and dorsal pancreatic artery was the most common site for development of both collateral circulations (16/22, 72.7%) and aneurysms (9/16, 56.3%). Splanchnic artery aneurysms were significantly more common in patients with collateral circulations (8/17, 47.1%) compared with those without collateral circulations (1/20, 5%) (P < 0.01). At least one peripancreatic vascular aneurysm was found in five of nine patients with splanchnic artery aneurysms (55.6%). CONCLUSION Splanchnic artery aneurysms are not uncommon in asymptomatic patients with collateral circulations caused by significant celiac trunk stenosis or obstruction due to median arcuate ligament. Therefore, careful imaging evaluation is necessary in patients with peripancreatic collateral circulations associated with MALS and regular follow-up is recommended for possibility of aneurysm development and rupture. Prophylactic endovascular treatment should be specifically performed in patients with pancreaticoduodenal arcade aneurysms to prevent life-threatening aneurysm rupture regardless of size.
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Affiliation(s)
- Subin Heo
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Hye Jin Kim
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Bohyun Kim
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Jei Hee Lee
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Jinoo Kim
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Jai Keun Kim
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
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Treatment Algorithm of Peripancreatic Arteries Aneurysm Coexisting with Coeliac Artery Lesion: Single Institution Experience. BIOMED RESEARCH INTERNATIONAL 2018; 2018:5745271. [PMID: 30112402 PMCID: PMC6077597 DOI: 10.1155/2018/5745271] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 07/05/2018] [Indexed: 11/21/2022]
Abstract
Introduction True aneurysms of peripancreatic arterial arcades (PAAAs) coexisting with celiac axis lesion are often asymptomatic. However, they may rupture regardless of their size and cause life-threatening hypovolemia. No treatment guidelines exist to date. We present a series of 21 patients and our management algorithm. Material and Methods For ruptured aneurysms we preformed endovascular embolization. Further treatment was dependent on patient's condition and control studies. In case of unruptured aneurysms, we assessed collateral circulation between superior mesenteric artery and celiac axis in angio-CT. If there was a pathway free from aneurysms, endovascular approach was chosen. Otherwise, surgical or combined treatment was favored. Results Endovascular treatment was performed in 14 patients with no complications. Follow-up studies revealed incomplete occlusion of the aneurysms in two cases. Surgical or combined treatment was performed in 7 patients with three serious perioperative complications. They were managed conservatively in two cases and surgically in one. Follow-up studies showed aneurismal dilatation and stenosis of a renohepatic by-pass in one case. Conclusion We present our management algorithm of PAAAs. Our results support the leading role of endovascular treatment. We present its limitations favoring surgical or combined treatment. All patients should be carefully followed.
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Dallara H, Habboushe J. Spontaneous inferior pancreaticoduodenal artery pseudoaneurysm rupture. Intern Emerg Med 2017; 12:1319-1321. [PMID: 28280981 DOI: 10.1007/s11739-017-1641-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 02/24/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Heidi Dallara
- Emergency Medicine Residency Program, Department of Emergency Medicine, Bellevue Hospital, New York University, 462 First Avenue Room A340, New York, NY, 10016, USA.
| | - Joseph Habboushe
- Ronald O. Perelman Department of Emergency Medicine, 550 1st Avenue, New York, NY, 10016, USA
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Ricci G, Riu P, Attinà GM, Trombetta S, Ialongo P, Di Cosimo C, Mancuso R, Marini P. Endovascular treatment of ruptured pancreaticoduodenal artery aneurysm: The importance of collateral vessels. A case report. Int J Surg Case Rep 2017; 41:205-208. [PMID: 29096344 PMCID: PMC5686227 DOI: 10.1016/j.ijscr.2017.10.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/18/2017] [Accepted: 10/22/2017] [Indexed: 11/26/2022] Open
Abstract
Ruptured pancreaticoduodenal artery aneursym is a very rare but potentially catastrophic occurence in an emergency department and its treatment is challenging. Very few cases of emergency endovascular treatment of ruptured visceral aneursyms are reported in the literature. This case report has the intention to elucidate in pancreaticodudoenal artery aneursym the importance of collateral vessels that could feed the aneurysm sac even after embolization of the inflow and outflow of the aneurysm.
Introduction True pancreaticoduodenal artery aneurysm occurrence is infrequent, but it is a fatal disease and accounts for accounts for <2% of all visceral aneurysms. Presentation of case A 62-year-old man with a two-day history of epigastric pain was admitted at emergency department. CT showed a retroperitoneal haematoma due to a 1.5 cm posterior inferior PDA ruptured aneurysm. Angiography had been conducted immediately: both inflow and outflow of the aneurysm were embolized. Another CT scan had been conducted, which revealed residual flow inside the aneurysm sac fed by small collateral vessels. Sub-selective catheterization was repeated and definitive haemostasis was obtained by embolizing the collateral vessels. Postoperative course was uneventful. CT scan follow-up at 36 months showed no abnormalities. Discussion The incidence rate of pancreaticoduodenal artery aneurysm rupture has been estimated to be less than or equal to 65%. In the case of rupture the treatment is challenging and mortality had been reported up to 50%. Endovascular treatment showed superior results as compared to surgical treatment of aneurysms, especially in emergency settings. Conclusion The authors elucidate the importance of occlusion of inflow and outflow of the aneurysm in conjunction with the occlusion of collateral vessels to avert reperfusion of the sac. Simultaneous handling of celiac axis stenosis is still prone to controversy: no relapse of aneurysm have been reported in patients with celiac axis stenosis at long-term follow-up, simultaneous treatment should be reserved when angiography is alarming for likely hepatic or duodenal ischemia.
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Affiliation(s)
- Gabriele Ricci
- Division of General and Emergency Surgery, Azienda Ospedaliera San Camillo-Forlanini, Circonvallazione Gianicolense 87, 00152 Rome, Italy.
| | - Pascale Riu
- Division of Interventional Radiology, Azienda Ospedaliera San Camillo-Forlanini, Circonvallazione Gianicolense 87, 00152 Rome, Italy
| | - Grazia Maria Attinà
- Division of General and Emergency Surgery, Azienda Ospedaliera San Camillo-Forlanini, Circonvallazione Gianicolense 87, 00152 Rome, Italy
| | - Silvia Trombetta
- Division of General and Emergency Surgery, Azienda Ospedaliera San Camillo-Forlanini, Circonvallazione Gianicolense 87, 00152 Rome, Italy
| | - Pasquale Ialongo
- Division of Radiology 2, Azienda Ospedaliera San Camillo-Forlanini, Circonvallazione Gianicolense 87, 00152 Rome, Italy
| | - Carla Di Cosimo
- Division of General and Emergency Surgery, Azienda Ospedaliera San Camillo-Forlanini, Circonvallazione Gianicolense 87, 00152 Rome, Italy
| | - Rosaria Mancuso
- Division of General and Emergency Surgery, Azienda Ospedaliera San Camillo-Forlanini, Circonvallazione Gianicolense 87, 00152 Rome, Italy
| | - Pierluigi Marini
- Division of General and Emergency Surgery, Azienda Ospedaliera San Camillo-Forlanini, Circonvallazione Gianicolense 87, 00152 Rome, Italy
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Pancreaticoduodenal Artery Aneurysm Associated with Celiac Trunk Stenosis: Case Illustration and Literature Review. Case Rep Radiol 2017; 2017:6989673. [PMID: 28815097 PMCID: PMC5549485 DOI: 10.1155/2017/6989673] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 06/19/2017] [Indexed: 11/17/2022] Open
Abstract
Pancreaticoduodenal artery aneurysms (PDA) are rare visceral aneurysms. Celiac trunk stenosis represents a common attributable aetiology for those aneurysms. Therefore, an alternative treatment approach, which differs from those isolated aneurysms, is recommended. We hereby present a 77-year-old male patient who was admitted with sudden onset of severe abdominal pain and significant drop in haemoglobin, occurring within a 24-hour interval. Contrast-enhanced computed tomography revealed a ruptured visceral aneurysm arising from the anterior branch of the inferior pancreaticoduodenal artery. A severe stenosis was also noted at the take-off of the celiac trunk. Selective catheterization of the supplying branch of the superior mesenteric artery, followed by coil embolization of the aneurysm, was performed, resulting in cessation of flow within the aneurysm, with preservation of the posterior branch, supplying the celiac territory. PDAs are usually asymptomatic and discovered incidentally at rupture. The risk of rupture is independent of the aneurysmal size and is associated with a 50% mortality rate. The consensus on coping with aneurysms is to treat them whenever they are discovered. Selective angiography followed by coil embolization represents a less invasive, and frequently definitive, approach than surgery. The risk for ischemia mandates that the celiac territory must not be compromised after embolization.
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Vandy FC, Sell KA, Eliason JL, Coleman DM, Rectenwald JE, Stanley JC. Pancreaticoduodenal and Gastroduodenal Artery Aneurysms Associated with Celiac Artery Occlusive Disease. Ann Vasc Surg 2017; 41:32-40. [DOI: 10.1016/j.avsg.2016.09.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/18/2016] [Accepted: 09/06/2016] [Indexed: 12/30/2022]
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Nasr LA, Faraj WG, Al-Kutoubi A, Hamady M, Khalifeh M, Hallal A, Halawani HM, Wazen J, Haydar AA. Median Arcuate Ligament Syndrome: A Single-Center Experience with 23 Patients. Cardiovasc Intervent Radiol 2017; 40:664-670. [DOI: 10.1007/s00270-016-1560-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 12/22/2016] [Indexed: 11/28/2022]
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Chivot C, Rebibo L, Robert B, Regimbeau JM, Yzet T. Ruptured Pancreaticoduodenal Artery Aneurysms Associated with Celiac Stenosis Caused by the Median Arcuate Ligament: A Poorly Known Etiology of Acute Abdominal Pain. Eur J Vasc Endovasc Surg 2016; 51:295-301. [DOI: 10.1016/j.ejvs.2015.10.025] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 10/29/2015] [Indexed: 10/22/2022]
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Tétreau R, Beji H, Henry L, Valette PJ, Pilleul F. Arterial splanchnic aneurysms: Presentation, treatment and outcome in 112 patients. Diagn Interv Imaging 2015; 97:81-90. [PMID: 26292616 DOI: 10.1016/j.diii.2015.06.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 06/08/2015] [Accepted: 06/30/2015] [Indexed: 12/14/2022]
Abstract
PURPOSE The purpose of this study was to identify subgroups with different risks of progression and their appropriate management among the heterogeneous group of 112 patients diagnosed with splanchnic aneurysm. METHODS Using radiology databases and medical records of our institution (Hospital Édouard-Hérriot, Lyon, France), we undertook a retrospective review of all patients diagnosed with splanchnic artery aneurysms from 1995 to 2011. Cases were analyzed by aneurysm location, etiology and a distinction was also made between true and false aneurysms. RESULTS False aneurysms were more likely than true aneurysms to be diagnosed as symptomatic and/or ruptured (TA: 50/66 patients asymptomatic vs. FA: 16/46 asymptomatic, P<0.05) with a rupture rate of 59% (27/46) which was unrelated to the size of aneurysms. Percutaneous treatment was carried in the majority of patients with a final success rate of 91%. Peripancreatic true aneurysms were associated in 75% of cases with celiac occlusive disease and diagnosed mostly in symptomatic patients (7/9: 78%) with a rupture rate of 44% unrelated to their size. Radiologic treatment has faced problems due to failure of catheterization and incomplete embolization, although there have been cases in which delayed occlusion was achieved. Common true aneurysms were incidental findings in 87% (57/66) of patients with 3 ruptured aneurysms which were larger than 2 cm. Observation in that group was safe: significant growth was seen only in one patient and the embolization required was successful. Splanchnic false aneurysms and peripancreatic true aneurysms carried a high and an unpredictable risk of rupture that warranted prompt endovascular treatment as soon as possible. CONCLUSIONS Stratification by localization and by the true or false appearance of the aneurysm was an effective (means of identifying) way to identify subgroups with different risks of progression. False aneurysms and peripancreatic true aneurysms carried a high and unpredictable risk of rupture. The splanchnic aneurysms should have been treated in the case of patients of childbearing age, size ≥ 20 mm, and in the case of liver transplantation. Other splanchnic aneurysms should either have been observed, if smaller than 2 cm. In the absence of rigorous published comparisons, surgical and endovascular methods should have been considered equally suitable in the elective treatment of these patients.
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Affiliation(s)
- R Tétreau
- Centre d'Imagerie Médicale, Institut du Cancer, 3, rue Croix-Verte, 34000 Montpellier, France
| | - H Beji
- Radiologie, CLCC Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - L Henry
- Radiologie, Hôpital Édouard-Hérriot, 69003 Lyon, France
| | - P-J Valette
- Radiologie, Hôpital Édouard-Hérriot, 69003 Lyon, France
| | - F Pilleul
- Centre d'Imagerie, CLCC Léon-Bérard, 28, rue Laennec, 69008 Lyon, France.
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Compression of the Celiac Artery by the Median Arcuate Ligament: Multidetector Computed Tomography Findings and Characteristics. Can Assoc Radiol J 2015; 66:272-6. [DOI: 10.1016/j.carj.2015.01.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 11/23/2014] [Accepted: 01/25/2015] [Indexed: 12/19/2022] Open
Abstract
Purpose The prevalence of the celiac artery stenosis caused by median arcuate ligament (MAL) compression and its multidetector computed tomography (MDCT) characteristics were evaluated in patients who underwent abdominal MDCT procedures, retrospectively. Methods Totally 1121 patients who had abdominal MDCT with arterial phase or MDCT angiography of the abdominal aorta for various indications were analyzed for celiac artery compression by the MAL. Results Fifty (ie, 4.6%) patients showed typical MDCT features of MAL compression. Focal narrowing of the proximal celiac artery, a characteristic hooked appearance of the narrowed segment without calcification and atherosclerotic changes were diagnostic. Poststenotic dilatation was detected in 22 (44%) patients with MAL compression. The ratio of the stenosis of the celiac artery was between 35%-50% in 15 patients and 51%-80% in 35 patients. The gastroduodenal artery diameter of these patients was not significantly different from the asymptomatic control group. Conclusion MALS is an uncommon entity but it should be kept in mind in the presence of unexplained gastrointestinal symptoms. MDCT is a minimally invasive and plays a dominant role in the diagnosis of MAL compression especially with reformatted and 3-D reconstructed images.
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Levin S, Graber J, Ehrenwald E, Skeik N. Polyarteritis nodosa-induced pancreaticoduodenal artery aneurysmal rupture. Int J Angiol 2015; 24:63-6. [PMID: 25780330 DOI: 10.1055/s-0033-1354306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Polyarteritis nodosa (PAN) is a systemic, necrotizing vasculitis of small- and medium-sized arteries typically with multiorgan involvement. Most cases of PAN are idiopathic, although hepatitis B or C virus infections and hairy cell leukemia are important in the pathogenesis of some cases. PAN is characterized as segmental transmural inflammation of muscular arteries. Diagnosis is based on clinical suspicion, a negative immunofluorescence test for antineutrophil cytoplasmic antibodies, and whenever possible, biopsy conformation. Angiographic images may reveal microaneurysms affecting the renal, hepatic, or mesenteric vasculature. Aneurysmal formation and rupture are important complications that can be fatal. Treatment may warrant immunosuppression with steroids and cyclophosphamide. If left untreated, PAN can be fatal. To our knowledge, we report the second documented case of PAN-induced ruptured inferior pancreaticoduodenal artery aneurysm.
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Affiliation(s)
- Steven Levin
- Division of Vascular Surgery, University of Minnesota Medical Center, Minneapolis, Minnesota
| | - John Graber
- Division of Vascular Surgery, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Eduardo Ehrenwald
- Division of Vascular Surgery, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Nedaa Skeik
- Division of Vascular Surgery, Abbott Northwestern Hospital, Minneapolis, Minnesota
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Lamba R, Tanner DT, Sekhon S, McGahan JP, Corwin MT, Lall CG. Multidetector CT of vascular compression syndromes in the abdomen and pelvis. Radiographics 2015; 34:93-115. [PMID: 24428284 DOI: 10.1148/rg.341125010] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Certain abdominopelvic vascular structures may be compressed by adjacent anatomic structures or may cause compression of adjacent hollow viscera. Such compressions may be asymptomatic; when symptomatic, however, they can lead to a variety of uncommon syndromes in the abdomen and pelvis, including median arcuate ligament syndrome, May-Thurner syndrome, nutcracker syndrome, superior mesenteric artery syndrome, ureteropelvic junction obstruction, ovarian vein syndrome, and other forms of ureteral compression. These syndromes, the pathogenesis of some of which remains controversial, can result in nonspecific symptoms of epigastric or flank pain, weight loss, nausea and vomiting, hematuria, or urinary tract infection. Direct venography or duplex ultrasonography can provide hemodynamic information in cases of vascular compression. However, multidetector computed tomography is particularly useful in that it allows a comprehensive single-study evaluation of the anatomy and resultant morphologic changes. Anatomic findings that can predispose to these syndromes may be encountered in patients who are undergoing imaging for unrelated reasons. However, the diagnosis of these syndromes should not be made on the basis of imaging findings alone. Severely symptomatic patients require treatment, which is generally surgical, although endovascular techniques are increasingly being used to treat venous compressions.
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Affiliation(s)
- Ramit Lamba
- From the Department of Radiology, University of California, Davis Health System, 4860 Y St, Suite 3100, Sacramento, CA 95817 (R.L., D.T.T., S.S., J.P.M., M.T.C.); and Department of Radiology, University of California, Irvine Medical Center, Irvine, Calif (C.G.L)
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Nishiyama A, Hoshina K, Hosaka A, Okamoto H, Shigematsu K, Miyata T. Treatment Strategies for a Pancreaticoduodenal Artery Aneurysm with or without a Celiac Trunk Occlusive Lesion. Ann Vasc Dis 2013; 6:725-9. [PMID: 24386022 DOI: 10.3400/avd.oa.13-00072] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 10/26/2013] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES A true pancreaticoduodenal artery aneurysm (PDAA) is a rare disease, and has some unique characteristics: a high rupture risk and a strong correlation with celiac trunk stenotic lesions (CTSL). We showed here that our treatment strategy for PDAA. MATERIALS AND METHODS Seven consecutive patients with PDAA at our institution from 1998 to 2011 were retrospectively reviewed. Of the 7 patients, five were male and two were female, with a mean age of 55 ± 9.7 years. Three aneurysms were diagnosed incidentally, and the remaining four ruptured. The locations of the aneurysm were the anterior superior pancreaticoduodenal artery (ASPDA) in 3 patients and the inferior pancreaticoduodenal artery (IPDA) in four. CTSL found 3 patients in the IPDA. RESULTS Of four ruptured patients, emergency catheter coil embolization was performed in three, and a simple ligation was performed in one. Three patients with non-ruptured aneurysms in the IPDA with a CTSL underwent direct aneurysm resection with arterial reconstruction. Six patients were successfully treated without complications or the appearance of new aneurysms during the follow-up period. CONCLUSION The treatment strategy for PDAA should be selected by the site of the aneurysm, the patients' condition, and the anatomical situation. A hybrid treatment could be considered a beneficial option for a CTSL.
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Affiliation(s)
- Ayako Nishiyama
- Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Katsuyuki Hoshina
- Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akihiro Hosaka
- Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Okamoto
- Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kunihiro Shigematsu
- Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tetsuro Miyata
- Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Robinson DR, Subramaniam PS, Bruening M, Benveniste GL. Multiple pancreaticoduodenal artery aneurysms with a primary duodenal fistula. J Vasc Surg 2013. [PMID: 23182483 DOI: 10.1016/j.jvs.2011.09.080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Domenic R Robinson
- Department of Surgery, the Queen Elizabeth Hospital, Woodville South, South Australia, Australia.
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Brocker JA, Maher JL, Smith RW. True pancreaticoduodenal aneurysms with celiac stenosis or occlusion. Am J Surg 2012; 204:762-8. [PMID: 22578409 DOI: 10.1016/j.amjsurg.2012.03.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 03/02/2012] [Accepted: 03/02/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND Pancreaticoduodenal artery (PDA) aneurysms are rare, representing only 2% of all visceral artery aneurysms. True PDA aneurysms associated with celiac stenosis or occlusion make up an even smaller subset of this group. No relationship between aneurysm size and the likelihood of rupture of PDA aneurysms is apparent. PDA aneurysm rupture is associated with a mortality rate upwards of 50%; therefore, accepted practice is treatment upon diagnosis. There is debate in the literature on whether the treatment of coexisting celiac axis stenosis is necessary for the prevention of recurrence. DATA SOURCES Literature relating to PDA aneurysms associated with celiac stenosis or occlusion was identified by performing a PubMed keyword search. References from identified articles were also assessed for relevance. The current literature was then reviewed and summarized. CONCLUSIONS Characteristics of this patient population are identified. Based on current evidence, our best practice recommendation for the treatment of coexisting celiac axis stenosis is provided.
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Affiliation(s)
- Jason A Brocker
- Department of General Surgery, Scott and White Healthcare/Texas A&M Health Science Center College of Medicine, Temple, TX 76508, USA
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Williamson JML, Cook JL, Jackson JE, Hocken DB. Infective aneurysm of the inferior pancreaticoduodenal artery. Ann R Coll Surg Engl 2011; 93:e87-8. [PMID: 21929894 DOI: 10.1308/147870811x590991] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Pancreaticoduodenal (PD) artery aneurysms account for less than 2% of all splanchnic aneurysms. A mycotic aetiology is extremely uncommon. INTRODUCTION Two weeks following an episode of sepsis related to a prostatic biopsy, a 59-year-old man presented with abdominal pain and anaemia. Ultrasonography and computed tomography revealed an inferior PD artery pseudoaneurysm with an associated mesenteric root haematoma. This was treated successfully by transcatheter embolisation. INTRODUCTION Infective pseudoaneurysms of the PD artery are rare but can be associated with rupture into the gastrointestinal tract or retroperitoneum. Transcatheter embolisation remains the most effective therapy as it is associated with low morbidity and mortality rates and recurrence is very unlikely provided the aneurysm is completely excluded from the circulation.
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Bowens NM, Woo EY, Fairman RM. Reno-hepatic artery bypass for an inferior pancreaticoduodenal artery aneurysm with associated celiac occlusion. J Vasc Surg 2011; 53:1696-8. [DOI: 10.1016/j.jvs.2011.02.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 02/11/2011] [Accepted: 02/11/2011] [Indexed: 11/29/2022]
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Cano-Valderrama O, Gallego-Béuter JJ, Giner M. Endovascular therapy as a treatment for ruptured pancreaticoduodenal artery aneurysms. MINIM INVASIV THER 2011; 20:296-300. [PMID: 21247252 DOI: 10.3109/13645706.2010.545233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Pancreaticoduodenal artery aneurysms (PDAAs) are uncommon. The treatment and prognosis for ruptured PDAAs have changed in recent years. A demonstrative case is reported. A review of the literature has been made and the case of a healthy man operated on an emergency basis because of a massive hemoperitoneum secondary to a ruptured PDAA is reported and analyzed with regard to the clinical presentation, radiologic findings, management, and outcome. A bleeding point was not detected at operation. An intraoperative arteriogram did not show active bleeding. The pancreas appeared infiltrated and oozing blood. The abdomen was gauze packed and the patient transferred for endovascular therapy (ET). Then, an arteriogram showed a bleeding PDAA. After embolization, bleeding ceased and the patient recovered. According to our literature survey, less than 200 cases of true and false PDAAs have been reported. For ruptured PDAAs, surgery is associated with high mortality since the bleeding point is usually not identified at operation. Similarly, intraoperative arteriograms are often fruitless due to the patient's poor hemodynamics plus suboptimal quality of the portable equipment. As shown in the present case and according to the specialized medical literature, ET has often been successful in the management of these patients and may be chosen as a first option for the treatment of ruptured PDAAs.
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Katsura M, Gushimiyagi M, Takara H, Mototake H. True aneurysm of the pancreaticoduodenal arteries: a single institution experience. J Gastrointest Surg 2010; 14:1409-13. [PMID: 20585995 DOI: 10.1007/s11605-010-1257-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Accepted: 06/07/2010] [Indexed: 01/31/2023]
Abstract
BACKGROUND True pancreaticoduodenal artery (PDA) aneurysm is a rare but potentially fatal disease. The aim of this study was to make recommendations for management of true PDA aneurysm. METHODS True aneurysms of the PDA were diagnosed at our institution between 1996 and 2007 and analyzed retrospectively, for clinical presentation, management, and outcome. RESULTS Eight patients were admitted to our institution for true aneurysms of the PDA. Five patients had aneurysmal rupture, and three were asymptomatic. In the rupture group, computed tomography (CT) showed the retroperitoneal hematoma around the pancreas and aneurysm, ranging from 5 to 25 mm (median, 12 mm). In the non-rupture group, CT revealed saccular aneurysm, ranging from 10 to 20 mm (median, 16 mm). The celiac axis was occluded in two patients, stenotic in four, and normal in two. Two patients underwent laparotomy, and we finally performed transcatheter arterial embolization in seven. All patients are alive, and there is no evidence of recurrence after median follow-up of 6 years. CONCLUSIONS We recommend treatment of all true PDA aneurysms at the time of diagnosis. True PDA aneurysm with celiac artery stenosis or occlusion requires precise techniques for embolization to preserve blood flow in the celiac artery territory.
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Affiliation(s)
- Morihiro Katsura
- Department of General Surgery, Okinawa Prefectural Hokubu Hospital, 2-12-3 Onaka, Nago, Okinawa, 905-8512, Japan.
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Takao H, Doi I, Watanabe T, Yoshioka N, Ohtomo K. Natural history of true pancreaticoduodenal artery aneurysms. Br J Radiol 2010; 83:744-6. [PMID: 20647516 DOI: 10.1259/bjr/17700576] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Advances in non-invasive diagnostic techniques, such as CT and ultrasonography, have improved our ability to detect unruptured pancreaticoduodenal artery aneurysms. No definitive study evaluating the natural history of these lesions or their preferred method of treatment has been published. In this report, we describe five patients with eight unruptured true pancreaticoduodenal artery aneurysms followed without treatment. Of these patients, four had coeliac axis stenosis (n = 1) or occlusion (n = 3) and one had occlusion of the superior mesenteric artery. The mean diameter of the aneurysms was 12.0 mm (range 7-17 mm). The mean duration of follow-up was 29.4 months (range 6-57 months). There was no aneurysm rupture during a total of 147 patient-months (243 aneurysm-months) of follow-up. Of the eight aneurysms, three increased in size over the follow-up period. We conclude that the risk of rupture of true pancreaticoduodenal artery aneurysms might be lower than expected from the data on ruptured aneurysms; however, careful follow-up of untreated aneurysms is necessary.
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Affiliation(s)
- H Takao
- Department of Radiology, Showa General Hospital, 2-450 Tenjincho, Kodaira, Tokyo, Japan.
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