Coil Embolization of Pancreaticoduodenal Artery Aneurysms Associated with Celiac Artery Stenosis: Report of Three Cases

Abstract

Aneurysms of the pancreaticoduodenal artery are rare. Degeneration of pancreaticoduodenal arcade vessels due to these aneurysms is associated with celiac artery stenosis or occlusion. Untreated lesions enlarge progressively and may rupture spontaneously. As the location of aneurysms of pancreaticoduodenal arcade vessels renders their surgical extirpation a challenge, we examined whether endovascular techniques offer a treatment alternative. We report on 3 patients with aneurysms of the pancreaticoduodenal arcade vessels and concomitant celiac artery stenosis/occlusion due to compression by the median arcuate ligament or chronic pancreatitis. All patients were treated by percutaneous coil embolization of the aneurysm. The aneurysmal sac was successfully excluded and the native circulation was preserved. Endovascular surgery can be used to treat these aneurysms safely and permits retention of the native circulation.

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

“…5) Varying degrees of celiac axis compression by the MAL are observed in 13%-50% of abdominal arteriograms, and severe stenosis of the celiac axis due to compression by the MAL is observed in 1% of arteriograms. 1,5) However, the prevalence of celiac axis stenosis due to compression by the MAL is unclear, especially in asymptomatic cases. We reviewed the PubMed database from 2000 to 2013, and found eight reports of Japanese patients with ruptured PDA aneurysms associated with compression of the celiac axis by the MAL (Table 1).…”

“…In addition, the higher mean age of patients with ruptured PDA aneurysms compared with patients treated for MALS without PDA aneurysms may reflect an age-related etiologic factor such as atherosclerosis, which was reported to be associated with the development of PDA aneurysms. 3,5) Strangely, chronic symptoms characteristic of MALS before PDA aneurysm rupture were reported in only one of the reviewed Japanese cases. 7) Separately from the reviewed Japanese patients, unruptured PDA aneurysms were discovered incidentally on abdominal CT examinations in four Japanese cases, and these patients did not have abdominal symptoms.…”

“…3,4) Factors associated with the formation of PDA aneurysms include atherosclerosis, local infection, trauma, pancreatitis, fibromuscular dysplasia, congenital anomalies, and compression of the celiac axis by the MAL. 3,5) The reported incidence of celiac axis stenosis ranges from 12.5% to 24.5% in Western populations. 5) Varying degrees of celiac axis compression by the MAL are observed in 13%-50% of abdominal arteriograms, and severe stenosis of the celiac axis due to compression by the MAL is observed in 1% of arteriograms.…”

“…3,5) The reported incidence of celiac axis stenosis ranges from 12.5% to 24.5% in Western populations. 5) Varying degrees of celiac axis compression by the MAL are observed in 13%-50% of abdominal arteriograms, and severe stenosis of the celiac axis due to compression by the MAL is observed in 1% of arteriograms. 1,5) However, the prevalence of celiac axis stenosis due to compression by the MAL is unclear, especially in asymptomatic cases.…”

Follow-up of true visceral artery aneurysm after coil embolization by three-dimensional contrast-enhanced MR angiography

“…Methods for follow-up imaging after endovascular treatment of vis- (6,7,(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). In regards to the follow-up imaging modality, CT examination was reported in 13 publications and was thus the most widely used (7,(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). In fact, CT was the only follow-up examination method used in nine of these publications (13,14,16,(19)(20)(21)(22)(23)(24).…”