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Ghoneim B, Nash C, Akmenkalne L, Cremen S, Canning C, Colgan MP, O'Neill S, Martin Z, Madhavan P, O'Callaghan A. Staged treatment for pancreaticoduodenal artery aneurysm with coeliac artery revascularisation: Case report and systematic review. Vascular 2024; 32:162-178. [PMID: 36071691 DOI: 10.1177/17085381221124991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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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Affiliation(s)
- Baker Ghoneim
- Department of Vascular Surgery, St James Hospital, Dublin, Ireland
| | - Connor Nash
- Department of Vascular Surgery, St James Hospital, Dublin, Ireland
| | - Liga Akmenkalne
- Department of Vascular Surgery, St James Hospital, Dublin, Ireland
| | - Sinead Cremen
- Department of Vascular Surgery, St James Hospital, Dublin, Ireland
| | - Catriona Canning
- Department of Vascular Surgery, St James Hospital, Dublin, Ireland
| | - Mary P Colgan
- Department of Vascular Surgery, St James Hospital, Dublin, Ireland
| | - Sean O'Neill
- Department of Vascular Surgery, St James Hospital, Dublin, Ireland
| | - Zenia Martin
- Department of Vascular Surgery, St James Hospital, Dublin, Ireland
| | - Prakash Madhavan
- Department of Vascular Surgery, St James Hospital, Dublin, Ireland
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Yu YN, Xu YS, Nie P, Min CC, Ding XL, Xu YH, Liu GP, Mao T. Ruptured small pancreaticoduodenal artery aneurysm-clinical features similar to pancreatitis: A case report. Medicine (Baltimore) 2023; 102:e32821. [PMID: 36862856 PMCID: PMC9981395 DOI: 10.1097/md.0000000000032821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Pancreaticoduodenal artery aneurysm (PDAA) is rare and has high rupture risks. PDAA rupture has a wide range of clinical symptoms, including abdominal pain, nausea, syncope, and hemorrhagic shock, which is difficult to differentiate from other diseases. PATIENT CONCERNS A 55-year-old female patient was admitted to our hospital due to abdominal pain for 11 days. DIAGNOSIS Acute pancreatitis was initially diagnosed. The patient's hemoglobin decreased compared to before admission, suggesting that active bleeding may occur. CT volume diagram and maximum intensity projection diagram show that a small aneurysm with a diameter of about 6 mm can be seen at the pancreaticoduodenal artery arch. The patient was diagnosed with a rupture and hemorrhage of the small pancreaticoduodenal aneurysm. INTERVENTIONS Interventional treatment was performed. After the microcatheter was selected for the branch of the diseased artery for angiography, the pseudoaneurysm was displayed and embolized. OUTCOMES The angiography showed that the pseudoaneurysm was occluded, and the distal cavity was not redeveloped. CONCLUSION The clinical manifestations of PDAA rupture were significantly correlated with the aneurysm diameter. Because of small aneurysms, the bleeding is limited around the peripancreatic and duodenal horizontal segments, accompanied by abdominal pain, vomiting, and elevated serum amylase, similar to the clinical manifestations of acute pancreatitis but accompanied by the decrease of hemoglobin. This will help us to improve our understanding of the disease, avoid misdiagnosis, and provide the basis for clinical treatment.
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Affiliation(s)
- Ya Nan Yu
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yu Shuang Xu
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Pei Nie
- Department of Radiology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Cong Cong Min
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xue Li Ding
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yong Hong Xu
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Guo Ping Liu
- Department of Interventional Medicine, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Tao Mao
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
- * Correspondence: Tao Mao, Department of Gastroenterology, Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong, China (e-mail: )
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Metzger PB, Costa KR, Silva SLE, Gouveia AC, Berbert MQ, Mello MODA, de Oliveira FM, Melo RFF. Inferior pancreaticoduodenal artery aneurysm: endovascular approach. J Vasc Bras 2021; 20:e20200101. [PMID: 34093677 PMCID: PMC8147707 DOI: 10.1590/1677-5449.200101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aneurysms of the pancreaticoduodenal arteries are a rare condition. In the majority of cases, diagnosis is made in emergency situations due to complications such as rupture, which is associated with high mortality rates (21-26%). Embolization of the aneurysm sac is the treatment of choice, because of its high efficacy and lower mortality. This article presents and discusses a case of inferior pancreaticoduodenal artery aneurysm that was diagnosed during investigation of gastrointestinal symptoms. The treatment provided was microcoil embolization, with complete exclusion of the aneurysm and a good clinical course.
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Li D, Ma J, Wei C, Zhao J, Yuan D, Zheng T. Hemodynamic Analysis to Assist Treatment Strategies in Complex Visceral Arterial Pathologies: Case Reports and discussion from Pancreaticoduodenal Artery Aneurysm with Superior Mesenteric Artery Occlusion. Ann Vasc Surg 2019; 59:308.e1-308.e8. [PMID: 31075464 DOI: 10.1016/j.avsg.2019.02.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/04/2019] [Accepted: 02/20/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Pancreaticoduodenal artery aneurysms (PDAAs) with occlusion of the superior mesenteric artery (SMA) are extremely rare. In the present study, we used computational fluid dynamics (CFD) to analyze the hemodynamics of a patient-specific PDAA with occlusion of the SMA preoperatively and then decide the treatment strategy in terms of the potential postoperative hemodynamics. METHODS A 3D model of a 69-old-year female with PDAA was reconstructed based on CT images. The virtual postoperative models of the aneurysmectomy with or without revascularization were numerically simulated in terms of hemodynamics including the flow field and wall shear stress (WSS). RESULTS Aneurysmectomy with revascularization would result in the original aneurysm site experiencing abnormally high WSS and pressure, which may possibly lead to the recurrence of PDAA. However, aneurysmectomy without revascularization would lead to stagnant flow in the blocked posterior-inferior pancreaticoduodenal artery (PIPDA). As a result, the PIPDA may soon be completely occluded after surgery and the SMA perfusion would be guaranteed. Finally, aneurysmectomy without revascularization was performed in this patient. The postoperative six-month computed tomography angiography result finely matched to the preoperative CFD simulation result. CONCLUSIONS This study gained insights into hemodynamics of PDAA. In addition, it demonstrated that utilization of CFD analysis also possibly helps assist the operation strategies for vascular diseases.
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Affiliation(s)
- Da Li
- Department of Applied Mechanics, Sichuan University, Chengdu, China
| | - Jinman Ma
- Department of Vascular Surgery of West China Hospital, Sichuan University, Chengdu, China
| | - Chijun Wei
- Department of Applied Mechanics, Sichuan University, Chengdu, China
| | - Jichun Zhao
- Department of Vascular Surgery of West China Hospital, Sichuan University, Chengdu, China
| | - Ding Yuan
- Department of Vascular Surgery of West China Hospital, Sichuan University, Chengdu, China.
| | - Tinghui Zheng
- Department of Applied Mechanics, Sichuan University, Chengdu, China.
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Multidetector Computed Tomographic Angiography for Optimal Cartography of the Visceral Abdominal Arterial Network: An Extensive Pictorial Review with Emphasis on Common and Uncommon Collateral Pathways, Complications and some Specific Syndromes. J Belg Soc Radiol 2017; 101:6. [PMID: 30038999 PMCID: PMC5854326 DOI: 10.5334/jbr-btr.1203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Multidetector computed tomographic angiography (MDCTA) is the new gold standard for diagnostic evaluation of the abdominal and/or mesenteric arteries. It is not invasive and provides a 2D and 3D global cartography of all abdominal arteries and that with only a limited amount of contrast media. MDCTA allows the optimal diagnosis of single or multiple arterial stenosis and easily analyses sometimes very complex collateral pathways. It constitutes a major advance to plan the arterial visceral safety of major commonly performed abdominal surgical procedures such as aorto-iliac surgery, endovascular aneurysm repair (EVAR), but also complex pancreatic and gastrointestinal or colonic surgery. It also allows to plan the most optimal strategy for revascularization of the mesenteric system through percutaneous angioplasty, stent placement or surgical bypass. This extensive pictorial review illustrates a large variety of situations which may be found during clinical practise. Single compression or stenosis of each digestive artery, combined and/or complex associations of stenosis and/or compressions of several arteries, secondary complications like aneurysms and classical but also sometimes unusual patterns of collateralization are richly illustrated. Specific syndromes comprising the median arcuate ligament syndrome (MALS) and the Leriche’s syndrome are also discussed.
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Sato M, Kawamoto S, Saiki Y. Pancreatic Arcade Artery Aneurysm-A Rare Complication after Replacement of Thoracoabdominal Aortic Aneurysm. Ann Vasc Dis 2016; 9:213-215. [PMID: 27738465 DOI: 10.3400/avd.cr.16-00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 04/28/2016] [Indexed: 11/13/2022] Open
Abstract
Aneurysm in the pancreatic arcade artery is an uncommon event, and is usually associated with the condition of median arcuate ligament syndrome. The stenosis at the base of the celiac axis has been presumed to be attributable to a relative increase in flow and pressure within the pancreatic arcade, resulting in subsequent development of the aneurysm. We, herein, present a rare case with rapid development of a pancreatic arcade artery aneurysm immediately after the replacement of a thoracoabdominal aortic aneurysm.
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Affiliation(s)
- Mitsuru Sato
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Shunsuke Kawamoto
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Sanal B, Nas OF, Hacikurt K, Hakyemez B, Erdogan C. Retrievable Stent-Assisted Coiling Technique Using a Solitaire Stent: Treatment of Pancreaticoduodenal Artery Aneurysm Associated With Celiac Artery Occlusion. Vasc Endovascular Surg 2016; 50:84-7. [PMID: 26983665 DOI: 10.1177/1538574416631644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
True aneurysm of pancreaticoduodenal arcade (PDA) is usually accompanied by stenosis or occlusion of celiac trunk (CeT). The up-to-date and first choice treatment modality of PDA aneurysm is the endovascular approach in nearly all cases except few selected ones necessitating surgery. The main approach in endovascular treatment is embolization of the aneurysm by preserving the parent artery. A case with concomitant CeT occlusion and PDA aneurysm was treated with coil embolization by preserving inferior pancreaticoduodenal artery with retrievable Solitaire(®) stent. In our knowledge, this is the first case with PDA aneurysm treated with this technique.
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Affiliation(s)
- Bekir Sanal
- Faculty of Medicine, Department of Radiology, Dumlupinar University, Kutahya, Turkey
| | - Omer Fatih Nas
- Faculty of Medicine, Department of Radiology, Uludag University, Bursa, Turkey
| | - Kadir Hacikurt
- Faculty of Medicine, Department of Radiology, Uludag University, Bursa, Turkey
| | - Bahattin Hakyemez
- Faculty of Medicine, Department of Radiology, Uludag University, Bursa, Turkey
| | - Cuneyt Erdogan
- Faculty of Medicine, Department of Radiology, Uludag University, Bursa, Turkey
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