Endovascular Management of Ruptured Pancreaticoduodenal Artery Aneurysms Associated with Celiac Axis Stenosis

Abstract

The purpose of this study was to assess the efficacy of transcatheter arterial embolization for ruptured pancreaticoduodenal artery (PDA) aneurysms associated with celiac axis stenosis (CS). Seven patients (four men and three women; mean age, 64; range, 43-84) were treated with transcatheter arterial embolization between 2002 and 2007. They were analyzed with regard to the clinical presentation, radiological finding, procedure, and outcome. All patients presented with sudden epigastric pain or abdominal discomfort. Contrast-enhanced CT showed a small aneurysm and retroperitoneal hematoma around the pancreatic head in all patients. The aneurysms ranged from 0.3 to 0.9 cm in size. In one patient, two aneurysms were detected. The aneurysms were located in the pancreaticoduodenal artery (n = 5) and the dorsal pancreatic artery (n = 3). Embolization was performed with microcoils in all aneurysms (n = 8). N-Butyl 2-cyanoacrylate (n = 1) and gelatine particle (n = 1) were also used. Complete occlusion was achieved in four patients. In the other three patients, a significantly reduced flow to the aneurysm remained at final angiography. However, these aneurysms were thrombosed on follow-up CT within 2 weeks. And there was no recurrence of the symptoms and bleeding during follow-up (mean, 28 months; range, 5-65 months) in all patients. In conclusion, transcatheter arterial embolization for PDA aneurysms associated with CS is effective. Significant reduction of the flow to the aneurysm at final angiography may be predictive of future thrombosis.

Infective aneurysm of the inferior pancreaticoduodenal artery

“…These aneurysms account for 2% of all splanchnic artery aneurysms. [1][2][3] Just over half are true arteriosclerotic aneurysms and many of these are associated with median arcuate ligament compression of the coeliac axis.…”

“…1,4,6,8 The PD arcade appears particularly susceptible to this aneurysmal degeneration, which tends to occur at vessel bifurcations. 4 Although very uncommon, rupture is usually retroperitoneal.…”

“…[1][2][3] The remainder are pseudoaneurysms, most commonly related to pancreatitis. Other causes include trauma, previous surgery, penetrating duodenal ulcers, infection, carcinomas and arteritis.…”

Spontaneous inferior pancreaticoduodenal artery pseudoaneurysm rupture

“…However, unlike other VAAs, pancreaticoduodenal aneurysms do not show a correlation between size and risk for break down [6]. Hemorrhage from pancreaticoduodenal pseudoaneurysms can vary from transient, recurrent episodes to massive, explosive events.…”

“…Symptoms may include abdominal pain, melena or hematochezia, hematemesis, biliary colic, jaundice, hemodynamic instability and shock. Morbidity and mortality has been reported as greater than 25% [6].…”