Management of pancreaticoduodenal artery aneurysm associated with coeliac artery stenosis

Kamarajah, Sivesh K.; Kharkhanis, S; Duddy, M.J.; J, Isaac; Sutcliffe, R.; Mehrzad, Homoyoon; Dasari, Bvm

doi:10.1308/rcsann.2019.0020

Cited by 2 publications

(11 citation statements)

References 16 publications

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“…4,6 Although the causes of PDAA are varied, the majority of PDAAs are caused by stenosis or occlusion of the CA. 3,4,7,10 CA occlusion has been reported to increase blood flow from the SMA to the inferior PDA and pancreatic arcades, resulting in increased arterial pressure and aneurysm formation. 12 If the PDAA is treated first, blood flow from the SMA through the PDA becomes blocked, and organs in the CA region may suffer ischemic damage.…”

Section: Discussionmentioning

confidence: 99%

“…Pancreaticoduodenal artery aneurysms (PDAA) are a subtype of visceral artery aneurysm (VAA) 1,2 . The incidence of VAAs is extremely low, ranging from 0.01% to 0.2%, 3,4 and PDAAs comprise only 2% of all VAAs 4–7 …”

Section: Introductionmentioning

confidence: 99%

“…1,2 The incidence of VAAs is extremely low, ranging from 0.01% to 0.2%, 3,4 and PDAAs comprise only 2% of all VAAs. [4][5][6][7] PDAAs are associated with stenosis or occlusion of the celiac artery (CA) or superior mesenteric artery (SMA) in 50%-80% of patients. 2 CA occlusion results in increased blood flow from the SMA to the pancreaticoduodenal artery (PDA), which not only compresses the PDA and leads to aneurysm formation, but also makes the PDA itself an important collateral blood vessel.…”

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confidence: 99%

“…8 Compensatory hyperdynamic flow through the SMA-PDA-gastroduodenal artery (GDA)-hepatic artery vasculature is thought to be the result of CA stenosis or occlusion. 7,9 Because of the high risk of rupture, the 2020 Society for Vascular Surgery clinical practice guidelines recommend treatment for…”

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confidence: 99%

“…Case 3 underwent contrast-enhanced CT to identify the thrombus within the aneurysm. 3D, three-dimensional; AIPDA, anterior inferior pancreaticoduodenal artery; ASPDA, anterior superior pancreaticoduodenal artery; CT, computed tomography; DPA, dorsal pancreatic artery; IPDA, inferior pancreaticoduodenal artery; J1A, first jejunal artery; PIPDA, posterior inferior pancreaticoduodenal artery; PSPDA, posterior superior pancreaticoduodenal artery; TPA, transverse pancreatic artery cases were diagnosed after rupture; therefore, blood flow in the PDA remained high, and intravascular pressure also remained high.An SA or common hepatic artery bypass supplies blood flow in the CA region and returns PDA blood flow and intravascular pressure closer to normal 4,7. In Cases 3 and 4, we treated only the largest aneurysm in each case, which was a giant aneurysm that was considered at high risk of rupture, and we left the other smaller aneurysms untreated, to simplify the procedure.…”

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confidence: 99%

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Treatment strategies for unruptured pancreaticoduodenal artery aneurysms associated with celiac artery occlusion

Koyama

Shimizu

Noguchi

et al. 2022

Annals of Gastroent Surgery

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Celiac artery (CA) occlusion or stenosis is identified in up to almost half of all patients undergoing abdominal angiography, and the resulting increased collateral blood flow from the superior mesenteric artery to the pancreaticoduodenal artery (PDA) may cause PDA aneurysms (PDAAs). PDAAs are rare but could be fatal if they rupture. However, treatment of the PDAA could block this important collateral blood flow pathway, leading to ischemic organ damage. Treatment of such aneurysms is therefore difficult, especially in patients with multiple PDAAs. Successful treatment of PDAAs requires establishing blood flow in the CA region and selecting which aneurysm(s) to treat. We present four patients who underwent surgery for unruptured PDAAs caused by CA obstruction. Blood flow in the CA region was established by bypassing the splenic artery and by anastomosing it either directly to the left renal artery (n = 1) or to the abdominal aorta using a graft (saphenous vein: n = 1; artificial vessel: n = 2). Three patients had multiple PDAAs: all PDAAs were treated in one patient with PDAAs of similar size and shape, but only the largest PDAA with the highest risk of rupture was treated in the other two patients to simplify the procedure. The median observation period was 19.5 months (range: 11‐28 months), and all patients were alive without recurrence at the time of writing. Surgical treatment including splenic artery bypass may thus be a viable option for treating patients with unruptured PDAAs.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Treatment strategies for unruptured pancreaticoduodenal artery aneurysms associated with celiac artery occlusion

Koyama

Shimizu

Noguchi

et al. 2022

Annals of Gastroent Surgery

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Staged treatment for pancreaticoduodenal artery aneurysm with coeliac artery revascularisation: Case report and systematic review

et al. 2022

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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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Management of pancreaticoduodenal artery aneurysm associated with coeliac artery stenosis

Cited by 2 publications

References 16 publications

Treatment strategies for unruptured pancreaticoduodenal artery aneurysms associated with celiac artery occlusion

Treatment strategies for unruptured pancreaticoduodenal artery aneurysms associated with celiac artery occlusion

Staged treatment for pancreaticoduodenal artery aneurysm with coeliac artery revascularisation: Case report and systematic review

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