Multiple large pancreaticoduodenal artery aneurysms due to celiac artery occlusion: Combination of the aorto-hepatic bypass and coil embolization with a dual approach through both the superior mesenteric artery and bypass

Ohta, Kengo; Shoji, Jumpei; Yoshida, Shiro; Takaishi, Tetsuo; Morimoto, Mamoru; Matsuo, Yoichi; Ogawa, Tatsuhito; Suda, Hisao; Shibamoto, Yuta

doi:10.1016/j.radcr.2020.10.031

Cited by 5 publications

(7 citation statements)

References 8 publications

(11 reference statements)

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“…Vascular structures such as those in Case 2 are prone to hemodynamic disturbance, which may lead to significant ischemic organ damage due to perioperative complications or graft failure. 5 In similar cases, it is effective to perform a revascularization procedure to ensure blood flow in the CA region and treat the aneurysm on a different day. 5 In Case 4, as in Case 2, with a weak LGA (Figure 3B ), the PDAA was treated on a different date.…”

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 …”

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.…”

mentioning

confidence: 99%

“…In fact, Case 2 was complicated by ischemic organ damage in the CA region owing to postoperative graft occlusion. Vascular structures such as those in Case 2 are prone to hemodynamic disturbance, which may lead to significant ischemic organ damage due to perioperative complications or graft failure 5. In similar cases, it is effective to perform a revascularization procedureF I G U R E 3 A, Comparison of the left gastric artery (LGA) and the dorsal pancreatic artery (DPA) in four cases by superior mesenteric artery digital subtraction angiography.…”

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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%

“… 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 …”

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

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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Prevalence of celiac artery compression by median arcuate ligament in patients with splanchnic artery aneurysms/pseudoaneurysms submitted to endovascular embolization

2023

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Purpose To study the association between median arcuate ligament compression (MALC) of celiac artery (CA) and splanchnic artery aneurysms/pseudoaneurysms (SAAPs) submitted to endovascular embolization. Methods Single center retrospective study of embolized SAAPs between 2010 and 2021, to evaluate the prevalence of MALC, and compare demographic data and clinical outcomes between patients with and without MALC. As a secondary objective, patient characteristics and outcomes were compared between patients with different causes of CA stenosis. Results MALC was found in 12.3% of 57 patients. SAAPs were more prevalent in the pancreaticoduodenal arcades (PDAs) in patients with MALC, compared to those without MALC (57.1% vs. 10%, P = .009). Patients with MALC had a greater proportion of aneurysms (71.4% vs. 24%, P = .020), as opposed to pseudoaneurysms. Rupture was the main indication for embolization in both groups (71.4% and 54% of patients with and without MALC, respectively). Embolization was successful in most cases (85.7% and 90%), with 5 immediate (28.6% and 6%) and 14 non-immediate (28.6% and 24%) post-procedure complications. Thirty and 90-day mortality rate were 0% in patients with MALC, and 14% and 24% in patients without MALC. Atherosclerosis was the only other cause of CA stenosis, in 3 cases. Conclusions In patients with SAAPs submitted to endovascular embolization, the prevalence of CA compression by MAL is not uncommon. The most frequent location for aneurysms in patients with MALC is in the PDAs. Endovascular management of SAAPs is very effective in patients with MALC, with low complications, even in ruptured aneurysms. Graphical Abstract

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Clinical Characteristics and Management of Peripancreatic Arterial Aneurysms: A 20-year Experience

Kang,

Kim,

Yang

et al. 2023

Angiology

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Pancreaticoduodenal and gastroduodenal artery aneurysms (PDAAs and GDAAs) are rare visceral aneurysms. Considering the rupture risk regardless of size, treatment should be provided promptly. We reviewed the characteristics and management of peripancreatic aneurysms in a retrospective, single-center review of consecutive patients with PDAAs and GDAAs between 2000 and 2022. Demographics, clinical characteristics, radiologic features, treatment, and outcomes were recorded. Nineteen PDAAs and seven GDAAs were identified in 24 patients. The median sizes of the PDAAs and GDAAs were 21 mm (range: 8–50 mm) and 14 mm (range: 11–32 mm), respectively. There were 4 ruptured cases (15.4%). Ten aneurysms (38.5%) had concomitant visceral aneurysms, and 16 (61.6%) were associated with celiac pathology. Aneurysms were managed using endovascular in 12 (46.2%), surgical in 4 (15.4%), and combined methods in 3 (11.5%) cases; 7 patients (26.9%) were lost to follow-up or refused treatments. During a median 13.8-month follow-up (range: 1–147.6), two complications (7.7%) occurred including pancreatitis and coil migration into the superior mesenteric artery after embolization within 30 days. After 30 days, aorto-common hepatic artery bypass graft stenosis was identified in one PDAA. Depending on the characteristics of peripancreatic aneurysms, endovascular, surgical, and hybrid approaches might all be practical treatment options.

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Multiple large pancreaticoduodenal artery aneurysms due to celiac artery occlusion: Combination of the aorto-hepatic bypass and coil embolization with a dual approach through both the superior mesenteric artery and bypass

Cited by 5 publications

References 8 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

Prevalence of celiac artery compression by median arcuate ligament in patients with splanchnic artery aneurysms/pseudoaneurysms submitted to endovascular embolization

Clinical Characteristics and Management of Peripancreatic Arterial Aneurysms: A 20-year Experience

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