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

Yamana, Fumio; Ohata, Toshihiro; Kitahara, Mutsunori; Nakamura, Masahisa; Yakushiji, Hideaki; Nakahira, Shin

doi:10.1016/j.jvscit.2019.10.005

Cited by 6 publications

(10 citation statements)

References 12 publications

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“…Owing to the relationship between the hemodynamics and pathogenesis of PDAAs, closer imaging follow-up after endovascular embolization is required in the presence of celiac occlusion or median arcuate ligament syndrome. 18 …”

Section: Discussionmentioning

confidence: 99%

Endovascular treatment of pancreaticoduodenal aneurysm with braided stent-assisted coil embolization using intraoperative cone-beam computed tomography guidance

Berczeli

Chinnadurai

McFall

et al. 2022

Journal of Vascular Surgery Cases, Innovations and Techniques

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Section: Discussionmentioning

confidence: 99%

Endovascular treatment of pancreaticoduodenal aneurysm with braided stent-assisted coil embolization using intraoperative cone-beam computed tomography guidance

Berczeli

Chinnadurai

McFall

et al. 2022

Journal of Vascular Surgery Cases, Innovations and Techniques

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“…5,6 In the published literature, celiac trunk stenosis accounts for approximately 63% of cases involving true PDA aneurysm formation. 1,2,7 A literature review by Vandy et al showed the main symptom associated with PDAA is abdominal pain observed in 54% of cases, with up to 26% being asymptomatic and the remainder with vague other symptoms. 8 Many PDAAs are found incidentally on CT scans for evaluation of unrelated pain or for followup of other disease processes.…”

Section: Discussionmentioning

confidence: 99%

“…15,16,9 Some advocate revascularization if celiac artery occlusive disease exists and if PDAA treatment would compromise collateral blood supply to the liver to avoid catastrophic hepatic ischemia. 17,7,18 An endovascular approach is our preferred management for both elective and ruptured cases. An endovascular approach is usually more expeditious than open surgery and associated with diminished blood loss and faster recovery.…”

Section: Discussionmentioning

confidence: 99%

“…5,6 In the published literature, celiac trunk stenosis accounts for approximately 63% of cases involving true PDA aneurysm formation. 1,2,7…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Management of Pancreaticoduodenal Artery Aneurysms Based on a Single-Institution Experience

Vani

Calligaro

Maloni

et al. 2021

Vasc Endovascular Surg

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Objectives: Pancreaticoduodenal artery aneurysms (PDAAs) are rare and have a high propensity for rupture. Historically, management of PDAAs included surgical reconstruction but has evolved with advances in endovascular therapy. We report our experience with management of PDAAs during the last 30 years. Methods: We retrospectively reviewed our prospectively maintained registry between January 1, 1992 – March 30, 2020. Results: We identified 8 patients with PDAAs: 4 with associated celiac artery occlusive disease and 4 without identifiable etiologies. Four patients were treated with surgical resection of the PDAAs: 2 intact aneurysms underwent concomitant revascularization (superior mesenteric artery-to-hepatic artery Dacron bypass; supra celiac aorta-to-hepatic artery Dacron bypass) and 2 (1 intact, 1 rupture) underwent ligation alone. Four patients were treated with coil embolization of the PDAA: 2 with concomitant stent-graft exclusion of the aneurysm (1 non-rupture, 1 rupture) and 2 without adjunctive measures (intact). There were no deaths nor any significant procedure-related morbidity. Conclusion: Our large single-center experience shows that PDAAs can be successfully treated by open or endovascular intervention with selective revascularization.

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Characteristics and Trends in Median Arcuate Ligament Syndrome (MALS) Associated Visceral Artery Aneurysms: A Systematic Descriptive Review of the Literature

Karanasios,

Ragab,

Cavenagh

et al. 2024

Vasc Endovascular Surg

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Introduction: Median Arcuate Ligament Syndrome (MALS) is associated with true aneurysms, mainly of both the pancreaticoduodenal artery (PDA) and gastroduodenal artery (GDA). Although rare, their potential for rupture and adverse clinical outcomes warrants analysis. Prior studies suggest high rupture rates even for smaller aneurysms under 2 cm in this setting. We performed a systematic literature review, synthesising the evidence on visceral artery aneurysms related to MAL syndrome, with a focus on descriptive analyses of aneurysm size, presentation, rupture rates, and management. Methods: Literature search was performed using (Medline, EMBASE, Emcare and CINAHL). Inclusion criteria included true aneurysms secondary to MALS with or without rupture. The cases with pseudoaneurysms, concomitant pathologies eg, pancreatitis, conservatively managed aneurysms and articles with non-granular pooled data were excluded. Cases were assessed according to demographics, clinical presentation, aneurysm diameter, aneurysm rupture and management technique. Results: 39 articles describing 72 patients were identified. Aneurysm diameter in symptomatic patients was not significantly different from asymptomatic patients {21.0 and 22.3 mm respectively, P = .84}. Ruptured aneurysms were overall smaller than non-ruptured at presentation {12.3 mm v 30.8 mm respectively, P = .02}. Patients presented with abdominal pain (75.6%), nausea/vomiting (15.6%), hypotension (33.9%), shock (20.0%) and haemodynamic collapse (8.9%). 56.9% of all cases were managed with an endovascular approach, 19.4% were managed with an open surgical approach, and 23.6% were managed hybrid. Conclusion: This review suggests visceral artery aneurysms associated with median arcuate ligament rupture at variable sizes. Despite inability to clearly correlate size and rupture risk, our data supports prompt intervention irrespective of size, given the adverse outcomes. Further research is critically needed to clarify size thresholds or other predictors to guide management.

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

Cited by 6 publications

References 12 publications

Endovascular treatment of pancreaticoduodenal aneurysm with braided stent-assisted coil embolization using intraoperative cone-beam computed tomography guidance

Endovascular treatment of pancreaticoduodenal aneurysm with braided stent-assisted coil embolization using intraoperative cone-beam computed tomography guidance

Management of Pancreaticoduodenal Artery Aneurysms Based on a Single-Institution Experience

Characteristics and Trends in Median Arcuate Ligament Syndrome (MALS) Associated Visceral Artery Aneurysms: A Systematic Descriptive Review of the Literature

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