A Case of Inferior Pancreaticoduodenal Artery Aneurysms with Celiac Artery Occlusion Treated by the Combination of Bypass Grafting and Embolization

善之, 中野; 実, 安齋; 啓介, 鎌田; 弘光, 菅原; 景襄, 蔡; 俊夫, 松橋; 和将, 清治; 正隆, 市来

doi:10.7133/jca.14-00010

Cited by 2 publications

(4 citation statements)

References 4 publications

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“…The optimal order of and duration of time between the two procedures (bypass surgery and coil embolization) have not yet been established. Two-stage treatment, which was applied in our two cases, was performed in six of the eight previously reported cases [4,9,11,12]. Theoretically, for a patient with a ruptured PDAA, one-stage treatment (emergent TAE combined with simultaneous bypass operation) might be necessary to attain rapid hemostasis and sufficient blood flow of upper abdominal organs such as the liver.…”

Section: Discussionmentioning

confidence: 90%

“…The therapeutic strategies for PDAAs involving the MAL must include both securement of the blood flow of the celiac arterial system and treatment of the aneurysm. The treatment methods used to secure the blood flow include both surgical procedures (MAL release and/or bypass surgery) and endovascular therapy (balloon dilation and/or celiac stenting) [4][5][6][7][8][9][10][11][12]. Treatment depends on the degree of celiac axis stenosis and the location and shape of the aneurysm.…”

Section: Discussionmentioning

confidence: 99%

“…Eight cases of combined bypass surgery and TAE for PDAAs have been reported to date [4,[9][10][11][12]. The characteristics of these previous cases are summarized in Table 1.…”

Section: Discussionmentioning

confidence: 99%

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Combined treatment of an aortosplenic bypass followed by coil embolization in the treatment of pancreaticoduodenal artery aneurysms caused by median arcuate ligament compression: a report of two cases

et al. 2021

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Background Pancreaticoduodenal artery aneurysms (PDAAs) are rare visceral aneurysms, and prompt intervention/treatment of all PDAAs is recommended at the time of diagnosis to avoid rupture of aneurysms. Herein, we report two cases of PDAA caused by the median arcuate ligament syndrome, treated with surgical revascularization by aortosplenic bypass followed by coil embolization. Case presentation Case 1 A 54-year-old woman presented with a chief complaint of severe epigastralgia and was diagnosed with two large fusiform inferior PDAAs and celiac axis occlusion. To preserve the blood flow of the pancreatic head, duodenum, liver, and spleen, we performed elective surgery to release the MAL along with aortosplenic bypass. At 6 days postoperatively, transcatheter arterial embolization was performed. At the 8-year 6-month follow-up observation, no recurrent perfusion of the embolized PDAAs or rupture had occurred, including the non-embolized small PDAA, and the bypass graft had excellent patency. Case 2 A 39-year-old man who had been in good health was found to have a PDAA with celiac stenosis during a medical checkup. Computed tomography and superior mesenteric arteriography showed severe celiac axis stenosis and a markedly dilated pancreatic arcade with a large saccular PDAA. To preserve the blood flow of the pancreatic arcade, we performed elective surgery to release the MAL along with aortosplenic bypass. At 9 days postoperatively, transcatheter arterial embolization was performed. At the 6-year 7-month follow-up observation, no recurrent perfusion or rupture of the PDAA had occurred, and the bypass graft had excellent patency. Conclusion Combined treatment with bypass surgery and coil embolization can be an effective option for the treatment of PDAAs associated with celiac axis occlusion or severe stenosis.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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Combined treatment of an aortosplenic bypass followed by coil embolization in the treatment of pancreaticoduodenal artery aneurysms caused by median arcuate ligament compression: a report of two cases

et al. 2021

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“…To the best of our knowledge, we have reviewed CT and angiography images in case reports published within a few decades. In most cases that can be assessed both before and after treatment, the dilated PDA arcade seemed to be normalized after successful treatment for celiac root stenosis or occlusion by revascularization or bypass [ 6 , 8 , 13 , 14 , 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous complete regression of pancreaticoduodenal artery aneurysms with celiac artery occlusion after aorto-splenic bypass without additional treatment: a case report

Fujiwara,

Kawamura,

Nakano

et al. 2024

surg case rep

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Background Pancreaticoduodenal artery aneurysm (PDAA) is a rare, but fatal disease. However, the association between aneurysm size and the risk of rupture remains unclear. There are many options for therapeutic strategies that should be discussed well because the treatment options are often complicated and highly invasive. However, it remains unclear whether additional endovascular therapy is essential for all patients undergoing bypass surgery. Here, we present a case of triple PDAAs with celiac axis occlusion and spontaneous complete regression of inferior PDAAs (IPDAA) after aneurysmectomy of superior PDAA (SPDAA) and aorto-splenic bypass. Case presentation A 68-year-old woman presented with one SPDAA and two IPDAAs caused by celiac axis occlusion. Aneurysmectomy for IPDAAs was difficult because of their anatomical location and shape. Therefore, we planned a two-stage hybrid therapy. The patient underwent aorto-splenic bypass and resection of the SPDAA. Follow-up CT was performed to evaluate the IPDAAs before planned endovascular embolization. Spontaneous regression of the IPDAAs and normalized PDA arcade decreased the blood flow in the PDA arcade. The patient is doing well without graft occlusion, and the IPDAAs have completely regressed 7 years after surgery. Conclusion Normalization of hyperinflow to the PDA arcade can lead to the regression of PDAA. Potentially, additional endovascular therapy may not be required in all cases when dilation of the PDA improves. However, more cases must be accumulated to establish criteria for predicting the risks of short- and long-term PDAA ruptures.

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A Case of Inferior Pancreaticoduodenal Artery Aneurysms with Celiac Artery Occlusion Treated by the Combination of Bypass Grafting and Embolization

Cited by 2 publications

References 4 publications

Combined treatment of an aortosplenic bypass followed by coil embolization in the treatment of pancreaticoduodenal artery aneurysms caused by median arcuate ligament compression: a report of two cases

Combined treatment of an aortosplenic bypass followed by coil embolization in the treatment of pancreaticoduodenal artery aneurysms caused by median arcuate ligament compression: a report of two cases

Spontaneous complete regression of pancreaticoduodenal artery aneurysms with celiac artery occlusion after aorto-splenic bypass without additional treatment: a case report

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