Treatment Options for Celiac Stenosis and Pancreaticoduodenal Artery Aneurysms

Abstract

Celiac stenosis may result in a pancreaticoduodenal artery aneurysm (PDAA). Celiac stenosis with a PDAA is rare and treatment guidelines are absent. Here, we report 4 cases of celiac stenosis treated using different methods. Of these, 3 involved PDAAs. The PDAAs were successfully treated with coil embolization. For celiac stenosis, we performed open surgery for decompression in 1 patient, stenting in 2 patients, and bypass grafting in 1 patient. In the patients who underwent stenting, stent-associated thrombosis occurred. PDAAs can be treated with coil embolization; however, treatment of celiac stenosis with the endovascular approach might be difficult.

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

“…However, the posterior superior pancreaticoduodenal artery was very thin, and we were concerned that it might not be enough to preserve hepatic arterial flow after embolization of aneurysms of the ASPDA, and thus we thought revascularization of the celiac artery was necessary. Although the celiac axis stenting was reported for celiac stenosis and pancreaticoduodenal artery aneurysms [5 , 6] , the celiac artery of this case was occluded and it might have been technically difficult. So, we decided to perform the aorto-hepatic artery bypass.…”

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

“…Both being rare disease entities, the high rate of up to 80% of concurrent CA stenosis and PDA aneurysm suggested a causal rather than coincidental relationship between the two conditions [14,15]. It is generally believed that the increase in the collateral flow due to stenosis or occlusion of the major aortic branches caused aneurysmal dilatation of the representative arteries [5,7,8,16]. However, it is possible that aneurysmal dilatation of the collateral arteries developed first, shunting the blood flow away from the major visceral arteries and causing it to collapse if their take-off point from the aorta was already tensed, as in median arcuate ligament syndrome [6].…”

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

“…In the case of PDAAs with celiac artery stenosis, TAE without revascularization of the celiac artery may lead to recurrence of PDAAs or ischemic dysfunction of the liver, spleen, or duodenum as a result of the absence of major collateral vessels. 1 Takeuchi et al 4 Journal of Vascular Surgery Cases and Innovative Techniques decompression in 1, and bypass grafting with saphenous vein in 1. They recommended surgical treatment of ligament release or arterial flow reconstruction because the endovascular approach might be difficult.…”

“…2 It is suggested that celiac artery stenosis due to compression by the median arcuate ligament (MAL) causes rupture of PDAAs, 3 which are thought to result from hemodynamic turbulence and an increase in peripancreatic collaterals. 4 Recently, the development of endovascular treatment has made it possible to perform transcatheter arterial embolization (TAE) of visceral aneurysms safely and effectively. 1,2 Moreover, TAE has been performed for first-line treatment of ruptured PDAAs.…”

“…Several choices for treatment of celiac artery stenosis in the presence of PDAAs have been reported, [1][2][3][4] but details of the therapeutic strategy, such as the follow-up term and treatment to prevent recurrence and secondary rupture of PDAAs, remain controversial. We describe a patient with multiple ruptured PDAAs associated with MAL compression.…”