Giant celiac artery aneurysm: Treatment by transcatheter coil embolization

Abstract

Celiac artery aneurysms (CAA) are one of the rarest forms of visceral artery aneurysms. Most patients are a symptomatic at the time of diagnosis and aneurysms are detected incidentally during diagnostic imaging for other diseases. We present the case of a 42-year-old man who had an asymptomatic giant CAA detected incidentally by an abdominal ultrasound investigating an abdominal pain. A contrast enhanced computed tomography angiogram (CTA) revealed a large CAA measuring 7.1 cm × 4.3 cm with extensive collaterals from the superior mesenteric artery (SMA). The aneurysm sac was mostly filled with thrombus with the celiac artery branches occluded. Pre-procedural angiography and transcatheter embolization procedures were performed at the same session. Endovascular exclusion was performed by transcatheter coil embolization and packing of the aneurysm sack. Technical success was achieved by the absence of flow in the aneurysm, and preservation of the native circulation on angiograms obtained just after the transcatheter coil embolization procedure. One week postembolization, a CTA confirmed thrombosis of the aneurysm. The patient returned for a follow-up CTA 3, 6, 12 and 48 months after embolization. The aneurysm was thrombosed and the patient remained a symptomatic. The surgical mode of treatment of CAA is increasingly being replaced by endovascular embolization because of the lower morbidity and mortality and high success rate. The accepted endovascular approach is by coil embolization of the aneurysmal lumen, the proximal and distal aneurysmal neck, or both.

Anatomical variations of the coeliac trunk in the homogeneous Polish population

“…The occurance of classical coeliac trunk trifurcation found in our study (92.7% of cases) concurs with Gümüs et al [10] who examined 820 patients and documented type I in 91.7% of cases. Despite the fact that isolated aneurysms of the coeliac trunk are very rare, 4% of all visceral arteries aneurysms, they can be easy detected and its classic pattern reduce a number of complications during surgical approaches or endovascular embolisation [2].…”

Successful endovascular treatment of a recurrent giant celiac artery aneurysm

“…Although almost 40% of all CAAs are idiopathic [5], [8], [15], [16], the most common etiology is atherosclerosis. Infection, trauma, polyarteritis nodosa, fibromuscular dysplasia with medial degeneration, poststenotic dilatation occasionally progressing to aneurysm, and Beçhet's disease are other etiologies implicated [6], [8], [15], [16], [17], [18]. Men are affected by CAA more often than women and CAAs usually present in the sixth decade of life.…”

“…Recent advances in abdominal imaging led to an increased frequency in the detection of VAAs [6], [8], [21]. On the one hand, CAAs are mostly asymptomatic.…”

“…Visceral artery aneurysms (VAA) are very rare––with an incidence reported of 0, 1%-2%––and aneurysms of the celiac trunk (CAA) are the rarest ones, since they constitute 4, 8-6, 3% of all VAA cases [1], [2], [3], [4], [5], [6]. CAAs are in most cases asymptomatic and, due to the wider application of sonography, computed tomography (CT) and endovascular aneurysm repair, they have been recognized with increased frequency in the recent past [5], [6], [7], [8]. Thus, their detection is frequently incidental.…”

“…In 15%-20% of cases, CAAs can manifest with rupture, with a mortality rate of about 80% [9], [10]. In this way, their early detection and treatment is really crucial, since the operative mortality rate of ruptured CAAs is 40% compared with 5% for elective repair [4], [6]. An aneurysm greater than 20 mm is worth to be treated, due to the risk of rupture: surgical treatment constitutes the traditional therapy, but it is related to a significant postoperative morbidity and mortality.…”