Polyarteritis Nodosa-Induced Pancreaticoduodenal Artery Aneurysmal Rupture

Levin, Steven; Graber, John N.; Ehrenwald, Eduardo; Skeik, Nedaa

doi:10.1055/s-0033-1354306

Cited by 7 publications

(3 citation statements)

References 27 publications

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“…Celiac axis lesion is the most common cause of true PAAAs formation. However, many other etiologies have been described, including vasculitis [ 1 ], fibrodysplasia [ 2 ], and congenital collagen disorders [ 3 ]. True PAAAs are rare and therefore literature covering this entity is scarce.…”

Section: Introductionmentioning

confidence: 99%

Aneurysms of Peripancreatic Arterial Arcades Coexisting with Celiac Trunk Stenosis or Occlusion: Single Institution Experience

Antoniak

Grabowska-Derlatka

Nawrot

et al. 2017

BioMed Research International

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Introduction. True aneurysms of peripancreatic arterial arcades (PAAAs) are rare. Most of them coexist with celiac axis stenosis/occlusion due to median arcuate ligament (MAL) compression or atherosclerosis. The aim of this study was to evaluate the cause of celiac axis lesion and characterize the anatomy of the aneurysms. These findings may have important management implications. Material and Methods. A retrospective analysis of 15 patients with true PAAAs was performed. The diagnosis was established by contrast-enhanced CT, using a 64-MDCT scanner. We evaluated the most probable cause of celiac axis lesion. Aneurysms were characterized by their number, location, size, and morphology. Location of the aneurysms was classified either as pancreaticoduodenal arteries (PDA) or as dorsal pancreatic arteries (DPA) as they may represent different collateral pathways between superior mesenteric artery and celiac trunk. Results. A total of 32 true PAAAs were identified. Celiac trunk was occluded in 12 patients and critically narrowed in 3 patients. Celiac axis lesion was categorized as secondary to MAL compression in 14 cases and due to atherosclerosis in 1 case. The most common location of the aneurysms was inferior pancreaticoduodenal arteries. Only in 1 case aneurysms involved both PDA and DPA. Conclusions. Coexistence of PAAAs with celiac axis compression as well as involvement of either PDAs or DPAs has important therapeutic implications. The uninvolved collateral pathway may be sufficient to preserve effective circulation in celiac trunk branches in case of resection or embolization of the aneurysms. However, further studies are crucial to confirm our findings.

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Section: Introductionmentioning

confidence: 99%

Aneurysms of Peripancreatic Arterial Arcades Coexisting with Celiac Trunk Stenosis or Occlusion: Single Institution Experience

Antoniak

Grabowska-Derlatka

Nawrot

et al. 2017

BioMed Research International

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“…Abdominal pain, caused by a spontaneous rupture of an intraabdominal artery is an exceptional presentation of PAN. [2,3] This type of vasculitis, which affects mainly middle-sized arteries, has an incidence rate between 4.4-9.7/million per year. This means that in the Netherlands, there should be only a hundred new patients per year.…”

Section: Discussionmentioning

confidence: 99%

Polyarteritis nodosa: An unusual cause of life-threatening intra-abdominal bleeding

Verdonk

Jonkman

Dees

2019

CRIM

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Intra-abdominal arterial bleeding is a life-threatening condition, warranting immediate causal therapy. Polyarteritis nodosa is a rare type of necrotizing vasculitis that affects medium-sized arteries. We present a patient with severe arterial bleeding as the first symptom of polyarteritis nodosa. Because the bleeding took place intra-abdominal instead of gastro-intestinal, there was no macroscopic blood loss. She was successfully treated with endovascular coil embolization during angiography.

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“…A VAA is a rare disease entity with an incidence of approximately 2%. Patients diagnosed with PAN, presenting with VAAs often show multiple sites of involvement [ 3 ]. In this patient, the PDA and the RGEA, which very rarely show the development of VAAs, were observed to show simultaneous involvement.…”

Section: Discussionmentioning

confidence: 99%

Hybrid Surgery to Treat Multiple Visceral Aneurysms Secondary to Polyarteritis Nodosa

Cho

Jae

et al. 2018

VSI

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A 57-year-old woman presented to vascular surgery clinic with visceral artery aneurysms that were incidentally detected during regular check-up. Imaging studies revealed occlusion of the celiac axis and severe stenosis of the superior mesenteric artery and 3 aneurysms along the posterior and inferior pancreaticoduodenal arteries, as well as the right gastroepiploic artery. Endovascular embolization of all aneurysms was rejected because of the risk of hepatic ischemia. These complicated lesion caused by polyarteritis nodosa were successfully treated using a hybrid operation with coil embolization, aneurysm resection, and antegrade aorto-celiac-superior mesentery artery bypass.

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Polyarteritis Nodosa-Induced Pancreaticoduodenal Artery Aneurysmal Rupture

Cited by 7 publications

References 27 publications

Aneurysms of Peripancreatic Arterial Arcades Coexisting with Celiac Trunk Stenosis or Occlusion: Single Institution Experience

Aneurysms of Peripancreatic Arterial Arcades Coexisting with Celiac Trunk Stenosis or Occlusion: Single Institution Experience

Polyarteritis nodosa: An unusual cause of life-threatening intra-abdominal bleeding

Hybrid Surgery to Treat Multiple Visceral Aneurysms Secondary to Polyarteritis Nodosa

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