Obstruction of the Celiac Axis Resulting in a Pancreaticoduodenal Artery Aneurysm

Abstract

A 47-year-old woman complained of abdominal pain, and a computed tomography scan indicated compressive obstruction of the celiac axis and a 4-cm retropancreatic aneurysm. An angiogram identified the aneurysmal vessel as the posterior pancreaticoduodenal artery. All foregut structures were supplied by this aneurysmal vessel. Via an open approach, the inflow and outflow of the aneurysm were ligated, and blood flow to the celiac axis was reconstructed via a bypass from the supraceliac aorta. A follow-up scan indicated complete thrombosis of the aneurysm. The patient is now symptom free. Open reconstruction of the celiac axis is mandatory when ligation of a pancreaticoduodenal aneurysm results in foregut ischemia. Ligation and reconstruction can be done safely and effectively in the elective setting.

Retrievable Stent-Assisted Coiling Technique Using a Solitaire Stent

“…The endovascular technique includes coil embolization and protection of the parent artery. 1,[6][7][8][9] Ikeda et al 8 performed embolization in their series with 11 patients by protecting the parent artery with a balloon compatible with the width of the aneurysm. In our case, the CeT was occluded and the PDA provided the blood supply.…”

“…3,4 The preferred treatment modality is the endovascular approach in nearly all cases, except few selected ones necessitating surgery. 1,[4][5][6] Embolization of the PDA aneurysm can be accomplished while preserving the parent artery. 4 Variety of devices used for this purpose increases, and new techniques come to light day by day.…”

Infective aneurysm of the inferior pancreaticoduodenal artery

“…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]5 Transcatheter embolisation is minimally invasive with a low risk of either serious complications or recurrent bleeding (when correctly performed). 3,5,6 The mortality rate of embolisation is zero, as opposed to 19% in surgical series. 3,5,6 Coaxial catheters are frequently required because of the small calibre and tortuosity of the vessels.…”

“…3,5,6 The mortality rate of embolisation is zero, as opposed to 19% in surgical series. 3,5,6 Coaxial catheters are frequently required because of the small calibre and tortuosity of the vessels. 3,5 Successful embolisation entails isolating the pseudoaneurysm from the circulation by placing embolic material on either side of its neck.…”