Pancreaticoduodenal artery aneurysms associated with celiac axis stenosis due to compression by median arcuate ligament and celiac plexus

Abstract

Celiac axis stenosis is frequently associated with pancreaticoduodenal artery aneurysms. Although the cause of stenosis was not clear in most of the reported cases, compression of the median arcuate ligament of the diaphragm was found to be responsible for the stenosis in 7 of 42 reported cases of this type of aneurysm. We report a case of aneurysm caused by compression of the median arcuate ligament of the diaphragm and celiac plexus. An asymptomatic 43-year-old Japanese man was admitted with a low echoic lesion in the uncus of pancreas. Computed tomographic scan and angiogram revealed stenosis of the celiac axis and two aneurysms in the inferior posterior pancreaticoduodenal artery. The celiac plexus and median arcuate ligament were divided surgically and normal flow was reestablished in the celiac axis. One of the aneurysms was resected and the afferent artery of the other aneurysm was ligated. In the setting of pancreaticoduodenal artery aneurysm associated with celiac axis stenosis, management of stenosis should be considered in addition to local treatment of the aneurysm. In this context, division of median arcuate ligament and celiac plexus or aorto-celiac bypass may normalize the flows in the pancreaticoduodenal arcade and could be effective in preventing aneurysm reformation.

Pancreatic Arcade Artery Aneurysm—A Rare Complication after Replacement of Thoracoabdominal Aortic Aneurysm

“…1) Etiology of the disease includes CA stenosis or occlusion, atherosclerosis, infection, and trauma. 1,2) In some cases, compression by the median arcuate ligament can explain the mechanism of CA stenosis. 3,4) Once the CA becomes stenotic or occluded, retrograde blood supply from the SMA into the pancreatic arcade is increased.…”

“…Generally, etiology of the disease includes celiac artery (CA) stenosis or occlusion, atherosclerosis, infection, and trauma. 1,2) In some cases, compression by the median arcuate ligament can explain the mechanism of CA stenosis 3,4) and subsequent aneurysmal formation. 5) Regarding the formation, that mechanism has been speculated that once the CA becomes stenotic or occluded, a flow and pressure within the pancreatic arcade relatively increase, resulting in subsequent development of the aneurysm.…”

Ruptured Pancreaticoduodenal Artery Aneurysm Associated with Median Arcuate Ligament Compression and Aortic Dissection Successfully Treated with Embolotherapy

“…[1][2][3][4][5][6] Segmental arterial mediolysis also causes PDA aneurysms. 7) The incidence of PDA aneurysm rupture is up to 65%, 1,3,6,8) and the risk of rupture appears to be unrelated to the size of the aneurysm.…”

“…10) Two strategies are available for the management of a PDA aneurysm: endovascular treatment and surgical resection. [1][2][3][4][5][6][7][8] Endovascular treatment, which includes coil embolization and stent grafting, is less invasive than surgical resection. Therefore, endovascular treatment should be attempted fi rst, if possible.…”

“…[1][2][3][4] In addition, a sudden hemodynamic change in the PDA, such as localized celiac artery dissection, 5) also causes PDA aneurysm rupture.…”