Two Patients with Ruptured Posterior Inferior Pancreaticoduodenal Artery Aneurysms Associated with Compression of the Celiac Axis by the Median Arcuate Ligament

Abstract

Patients with compression of the celiac axis by the median arcuate ligament may develop aneurysms in the pancreaticoduodenal arcades. We experienced two cases of ruptured pancreaticoduodenal artery aneurysm associated with this condition. Both patients presented with abdominal pain and shock, and abdominal contrast-enhanced computed tomography showed retroperitoneal hematoma and compression of the celiac axis by the median arcuate ligament. Both patients were successfully treated by coil embolization. Patients with celiac axis compression or stenosis may develop recurrent aneurysms unless revascularization of the celiac axis is performed. Long-term follow-up is required because aneurysms may develop after 10 years or longer.

Ruptured Pancreaticoduodenal Artery Aneurysm Associated with Median Arcuate Ligament Compression and Aortic Dissection Successfully Treated with Embolotherapy

“…[1][2][3][4][5][6] Segmental arterial mediolysis also causes PDA aneurysms. 7) The incidence of PDA aneurysm rupture is up to 65%, 1,3,6,8) and the risk of rupture appears to be unrelated to the size of the aneurysm.…”

“…7) The incidence of PDA aneurysm rupture is up to 65%, 1,3,6,8) and the risk of rupture appears to be unrelated to the size of the aneurysm. 4) In a review of 88 patients with PDA aneurysms, 53 experienced rupture, which was fatal in 26 (49.1%). 8) MAL is a fi brous arch that connects the left and right diaphragmatic cruras, defi ning the anterior margin of the aortic hiatus, and causes celiac artery stenosis by extrinsic compression.…”

“…Relieving the MAL compression would theoretically decrease recurrence of aneurysms in the PDA, although no recurrences have been reported in the literature after successful embolization of the aneurysm alone. 3,4) In this case, long-term follow-up is required to check the recurrence of aneurysms because the hemodynamic stress on the PDA still remains after the treatment. In summary, we report a case of a ruptured PDA aneurysm caused by MAL and aortic dissection.…”

“…10) Two strategies are available for the management of a PDA aneurysm: endovascular treatment and surgical resection. [1][2][3][4][5][6][7][8] Endovascular treatment, which includes coil embolization and stent grafting, is less invasive than surgical resection. Therefore, endovascular treatment should be attempted fi rst, if possible.…”

“…[1][2][3][4] In addition, a sudden hemodynamic change in the PDA, such as localized celiac artery dissection, 5) also causes PDA aneurysm rupture.…”