Causal Relationship between Celiac Stenosis and Pancreaticoduodenal Artery Aneurysm: Interpretation by Simulation Using an Electric Circuit

Abstract

Pancreaticoduodenal artery (PDA) aneurysm and celiac artery (CA) stenosis are rare diseases in themselves. Interestingly, however, there are more cases documented in the literature in which these two disease entities occurred together than could be coincidental, and CA stenosis has been suggested as the provocative condition in developing PDA aneurysm. This study is aimed at examining the causal relationship between CA stenosis and PDA aneurysm by simulating the splanchnic circulation with an electric circuit. A patient with multiple PDA aneurysms and collaterals with CA stenosis was treated in our institution using hybrid techniques. The patient’s pre- and postoperative status was simulated using an electric circuit, and the two possible scenarios were tested for compatibility: the stenosis-first scenario vs. the aneurysm-first scenario. The simulation was performed in two ways: using Simulink® software (MATLAB® Release 2018b) and actual circuit construction on a breadboard. The stenosis-first scenario showed that as the CA stenosis progresses, the blood flow through PDA increases, favoring the development of an aneurysm and/or collaterals if the artery was already compromised by a weakening condition. On the other hand, the aneurysm-first scenario also showed that if the aneurysm or collaterals developed first, the aneurysm will steal the blood flow through the CA, causing it to collapse if the artery was already compromised by increased wall tension. Contrary to the common belief, this study showed that in patients suffering from concurrent CA stenosis and PDA aneurysm, either condition could develop first and predispose the development of the other. The simulation of splanchnic blood flow with an electric circuit provides a useful tool for analyzing rare vascular diseases that are difficult to provoke in clinical and animal studies.

Endovascular treatment of pancreaticoduodenal aneurysm with braided stent-assisted coil embolization using intraoperative cone-beam computed tomography guidance

“… 3 An association between celiac trunk stenosis and PDAA has been reported, with a speculated flow-related causal relationship for both stenosis-first and aneurysm-first scenarios. 13 Our patient had had celiac artery occlusion with collateralization from the SMA, which had prompted our decision to treat the PDAA first. Given the better spatial resolution and intra-arterial contrast injection, CBCTA was performed to better understand the PDAA morphology and delineate the treatment options.…”

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

“…Li et al simulated the flow field WSS of a patient with PDAA accompanied by SMA occlusion to predict the outcome of different operation strategies ( 25 ). Additionally, Yonn et al used an electric circuit model to explore the relationship between CA stenosis and PDA perfusion ( 26 ). Our study demonstrated that this condition could also be directly simulated with CFD analysis.…”

“…Little association was found between the WSS states and the location or size of aneurysms, suggesting that the initiation and growth of aneurysms were not simply influenced by the primary blood flow rates or vessel diameters. Aneurysm progression could reversely influence local hemodynamics states, possibly ameliorate or accelerate its growth ( 26 , 28 ). Nevertheless, since the time course of disease before diagnosis was neither available nor consistent for every patient, we could only remove all aneurysms and evaluate them at hypothetically “initial” conditions.…”

Calcified pancreatoduodenal artery aneurysm with filiform celiac stenosis: Follow up for ~6 years (70 months) with no intervention

“…which leads to an increased pressure in PDA, and in gastroduodenal arteries (GDA), leading to an increased artery wall tension, with subsequent arterial wall weakening and aneurysm development [5]. However, Hye Jeong Yoon et al have shown that a reverse causal relationship may also be possible, theoretically, demonstrating it based on the simulation using an electric circuit, where the development of aneurysm may result in proximal artery stenosis or occlusion, may it be a superior mesenteric artery or celiac trunk [6].…”