Pancreaticoduodenal Artery Aneurysms Secondary to Median Arcuate Ligament Syndrome May Not Need Celiac Artery Revascularization or Ligament Release

Sgroi, Michael D.; Kabutey, Nii-Kabu; Krishnam, Mayil S.; Fujitani, Roy M.

doi:10.1016/j.avsg.2014.05.020

Cited by 45 publications

(38 citation statements)

References 26 publications

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“…This has been reported to lead to a reduction of arterial pressure on PDA and to reduce recurrence rates (14). Similar results have been reported for patients that did not undergo coeliac devascularization (15). In our patient group, on the other hand, coeliac devascularization was not applied and no additional problems were seen during follow-up.…”

Section: Discussionsupporting

confidence: 89%

Pancreaticoduodenal artery aneurysm: Treatment outcomes of a rare disorder

Aydın¹,

Soy²,

Boyvat³

et al. 2018

Medical Science and Discovery

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Objective: Pancreaticoduodenal artery aneurysm is a rare vascular disorder that manifests with a clinical presentation ranging from asymptomatic cases to hemorrhagic shock due to aneurysm rupture. In this study, we aimed to evaluate the outcomes of patients treated with different methods for pancreaticoduodenal artery aneurysm. Material and Methods: A total of 5 patients who were treated and followed for pancreaticoduodenal artery aneurysm between January 2011 and January 2018 were enrolled in the study. Standard endovascular embolization and surgical resection were performed. The demographic findings and treatment outcomes were compared. Results: All patients were shown to have a pancreaticoduodenal artery aneurysm by radiological methods. The most common complaint was abdominal pain. The mean aneurysm size was 2.8 cm. Two patients had coeliac axis stenosis and occlusion, one had hypertension, one had Marfan syndrome, and one had chronic pancreatitis as the possible etiological cause. One patient with occlusion of the coeliac axis had thrombus, one patient with coeliac axis stenosis had median arcuate ligament compression. Three patients were treated with embolization, one with surgery, and one with low-molecular weight heparin. Conclusion: Different etiological factors and multiple vascular problems accompanying the disorder create difficulties for establishing a treatment algorithm. Due to the rare nature of the disease, studies available in the literature involve limited numbers of patients, as was also the case in our study. There appeared to be no significant differences between the treatment and follow-up duration among the different treatment methods we applied for our patients.

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Section: Discussionsupporting

confidence: 89%

Pancreaticoduodenal artery aneurysm: Treatment outcomes of a rare disorder

Aydın¹,

Soy²,

Boyvat³

et al. 2018

Medical Science and Discovery

View full text Add to dashboard Cite

show abstract

“…In contrast, several authors have reported that revascularization for celiac stenosis after TAE may not be necessary because there was no recurrence of the aneurysm after TAE during the follow-up term. 10 In our case, follow-up CT 1 month after initial TAE for ruptured PDAA showed rapid expanding residual aneurysm and new left gastric artery dissection. Additional therapy was necessary for the prevention of rerupture.…”

Section: Discussionmentioning

confidence: 45%

Blood flow modification might prevent secondary rupture of multiple pancreaticoduodenal artery arcade aneurysms associated with celiac axis stenosis

Yamana

Ohata

Kitahara

et al. 2020

Journal of Vascular Surgery Cases, Innovations and Techniques

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A pancreaticoduodenal artery arcade aneurysm (PDAA) is rare and often associated with celiac axis stenosis by the median arcuate ligament. Although rupture risk of the PDAA is not related to its size, treatment guidelines are absent. Here we describe a 59-year-old woman with multiple ruptured PDAAs associated with celiac axis stenosis who was successfully treated with coil embolization. As follow-up computed tomography revealed rapid expansion of residual PDAAs and new gastric artery dissection, median arcuate ligament resection was followed by aorta-common hepatic artery bypass, which resulted in aneurysmal regression. Blood flow modification might prevent secondary rupture of PDAA associated with celiac axis stenosis.

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“…Thus, it is reported that treatment is necessary even if the diameter of the aneurysm is small [11]. There are some reports that a MAL release can be postponed for aneurysms in the pancreatic head region arteries, even for multiple ones [12]. Similarly, in the present case, we thought that a MAL incision would decrease blood flow from the superior mesenteric artery to the pancreatic head arcade and reduce the risk of rupture of the untreated aneurysms.…”

Section: Discussionsupporting

confidence: 53%

Metachronous rupture of a residual pancreaticoduodenal aneurysm after release of the median arcuate ligament: a case report

et al. 2020

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Background: Multiple pancreaticoduodenal artery aneurysms in association with median arcuate ligament syndrome (MALS) are relatively rare. A treatment option, such as a median arcuate ligament (MAL) release or embolization of the aneurysms, should be considered in such cases, but the treatment criteria remain unclear. Case report: A 75-year-old man was transferred to our hospital because of a ruptured pancreaticoduodenal aneurysm. Emergency angiography showed stenosis of the root of the celiac axis (CA), a ruptured aneurysm of the posterior inferior pancreaticoduodenal artery (PIPDA), and an unruptured aneurysm of the anterior inferior pancreaticoduodenal artery (AIPDA). Coil embolization of the PIPDA was performed. Five days after embolization, the gallbladder became necrotic due to decreased blood flow in the CA region, and an emergency operation was performed. We performed a cholecystectomy and released the MAL to normalize the blood flow of the CA region. However, the patient died on postoperative day 8 because of rupture of the untreated aneurysm of the AIPDA. Conclusions: This is the first report of metachronous ruptures of multiple pancreaticoduodenal aneurysms due to MALS, even after a MAL release. Although rare, a residual aneurysm in the pancreatic head region may need to be embolized quickly.

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Pancreaticoduodenal Artery Aneurysms Secondary to Median Arcuate Ligament Syndrome May Not Need Celiac Artery Revascularization or Ligament Release

Cited by 45 publications

References 26 publications

Pancreaticoduodenal artery aneurysm: Treatment outcomes of a rare disorder

Pancreaticoduodenal artery aneurysm: Treatment outcomes of a rare disorder

Blood flow modification might prevent secondary rupture of multiple pancreaticoduodenal artery arcade aneurysms associated with celiac axis stenosis

Metachronous rupture of a residual pancreaticoduodenal aneurysm after release of the median arcuate ligament: a case report

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