Embolization of Ruptured Aneurysm of the Pancreaticoduodenal Artery Secondary to Long-standing Stenosis of The Celiac Axis

Abstract

Long-standing stenosis of the celiac axis is a rare cause of aneurysm of the inferior pancreaticoduodenal artery, which serves as a collateral pathway; the etiology is believed to be due to turbulence from increased blood flow. The authors describe 2 cases of such aneurysm, which ruptured in the retroperitoneum and were treated with transcatheter embolization.

Re: Embolization of pancreaticoduodenal aneurysms associated with occlusive disease of the celiac artery

“…We agree with Uher et al [1] when they state that embolization should be the primary therapeutic choice in the case of a ruptured aneurysm: the successful longterm results support this approach [2]. However, we feel that embolization should be primarily attempted in patients with a nonruptured aneurysm when the vascular anatomy is suitable for selective catheterization because an arterial ligation or an aneurysm resection are not always feasible, and a major operation (i.e., a partial pancreatectomy) might be necessary [3,4].…”

“…We read with interest the paper by Uher et al concerning aneurysms of the pancreaticoduodenal artery associated with occlusion of the celiac artery [1], and we would like to add the following considerations.…”

Management of True Aneurysms of the Pancreaticoduodenal Arteries

“…'7 In addition, embolization may be associated with aneurysmal rupture during the procedure or ischemic injury resulting from the absence of major collateral vessels.' 1,16,18 Although recurrent hemorrhage is less likely in true aneurysms than in pseudoaneurysms, which are usually associated with persistent pancreatic inflammation, such complications may still occur, and close observation of the patient is mandatory.…”

Spontaneous Rupture of the Pancreaticoduodenal Artery Possibly Related to Prior Occlusion of the Common Hepatic Artery: Report of a Case

“…It should be borne in mind that transcatheter embolization is not always technically possible and that rerupture of the aneurysm may occur during attempted transcatheter embolization. 21 Although we understand that angiographic studies are necessary and usually the best choice in these patients, we decided that a laparotomy could not be delayed until after angiography in our patient because of his rapidly progressive and uncontrollable hemorrhagic shock. After achieving hemostasis by the simplest method possible, angiography should still be performed to investigate the vascular abnormality and assist in planning further treatment such as embolization or surgery if necessary.…”

“…The reported frequency of rupture is 50%-65% of all diagnosed PDA aneurysms, and rupture occurred in 25 of 48 reported true PDA aneurysms associated with celiac axis or common hepatic artery stenosis or occlusion (Table 1). 3,5,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] For the correct diagnosis of this condition, angiographic examination is Although we had scheduled interventional radiology for our patient, an emergency laparotomy was performed before this could be carried out because progressive hemorrhagic shock rapidly developed while in the emergency room. It should be borne in mind that transcatheter embolization is not always technically possible and that rerupture of the aneurysm may occur during attempted transcatheter embolization.…”