Aneurysms of Peripancreatic Arterial Arcades Coexisting with Celiac Trunk Stenosis or Occlusion: Single Institution Experience

Abstract

Introduction. True aneurysms of peripancreatic arterial arcades (PAAAs) are rare. Most of them coexist with celiac axis stenosis/occlusion due to median arcuate ligament (MAL) compression or atherosclerosis. The aim of this study was to evaluate the cause of celiac axis lesion and characterize the anatomy of the aneurysms. These findings may have important management implications. Material and Methods. A retrospective analysis of 15 patients with true PAAAs was performed. The diagnosis was established by contrast-enhanced CT, using a 64-MDCT scanner. We evaluated the most probable cause of celiac axis lesion. Aneurysms were characterized by their number, location, size, and morphology. Location of the aneurysms was classified either as pancreaticoduodenal arteries (PDA) or as dorsal pancreatic arteries (DPA) as they may represent different collateral pathways between superior mesenteric artery and celiac trunk. Results. A total of 32 true PAAAs were identified. Celiac trunk was occluded in 12 patients and critically narrowed in 3 patients. Celiac axis lesion was categorized as secondary to MAL compression in 14 cases and due to atherosclerosis in 1 case. The most common location of the aneurysms was inferior pancreaticoduodenal arteries. Only in 1 case aneurysms involved both PDA and DPA. Conclusions. Coexistence of PAAAs with celiac axis compression as well as involvement of either PDAs or DPAs has important therapeutic implications. The uninvolved collateral pathway may be sufficient to preserve effective circulation in celiac trunk branches in case of resection or embolization of the aneurysms. However, further studies are crucial to confirm our findings.

Patient-specific modeling of hemodynamic characteristics associated with the formation of visceral artery aneurysms at uncommon locations

“…Notably, all PDAA included had various degrees of SMA or CA stenosis, which was consistent with previous findings ( 6 ). It had been reported that stenosis or occlusion of proximal intracranial arteries could lead to increase WSS at distal areas, which was associated with aneurysm formation ( 22 , 23 ).…”

“…Aneurysms of the rest of visceral arteries, however, were less studied because of their rarity. An interesting phenomenon has been observed on several occasions where stenosis of the celiac axis, mostly from median arcuate ligament syndrome, could result in an increased flow through the PDA and might be associated with the development of aneurysms ( 5 , 6 ). However, the etiologies of VAA are complicated and still require investigation.…”

Recurrent IPDA Aneurysm from Celiac Occlusion Treated by a Flow Diverting Stent

“…IPDA aneurysms are rare but often associated with celiac stenosis or occlusion from median arcuate ligament compression or atherosclerotic disease. [1][2][3][4] It has long been hypothesized that retrograde flow through the IPDA arcade causes enlargement of these small vessels and promotes aneurysm development. 1,2,4 However, objective proof of this hypothesis is lacking given the fact that celiac stenosis or occlusion and IPDA aneurysms are most often diagnosed concurrently.…”

Active Overt Obscured Gastrointestinal Bleeding Due to Ectasia of the Anterior Inferior Pancreaticoduodenal Artery and Its Endovascular Management in a Treated Case of Superior Mesenteric Artery Stenosis

“…Other etiologies include vasculitis, fibromuscular dysplasia, and congenital collagen disorders. 5 Hemodynamically significant stenosis of celiac axis causes increased flow through the pancreaticoduodenal arterial arcade and leads to the formation of true aneurysms. Most of these patients are treated with coil embolization when symptomatic.…”