The presentation and management of aneurysms of the pancreaticoduodenal arcade

Abstract

GDAAs and PDAAs are uncommon lesions that are often associated with a celiac axis stenosis/occlusion leading to altered hemodynamics in the pancreaticoduodenal arcade. These aneurysms are prone to rupture regardless of size, and intervention is accordingly recommended for all aneurysms upon recognition. Despite the concordant celiac axis obstruction and concern for maintenance of hepatic circulation, endovascular repair of these aneurysms is generally successful and should be considered as the initial operative approach.

Treatment Algorithm of Peripancreatic Arteries Aneurysm Coexisting with Coeliac Artery Lesion: Single Institution Experience

“…In our series only one patient presented with ruptured aneurysm and urgent embolization was successful. Other authors confirmed usefulness of endovascular procedures in emergent situation [ 12 , 13 ]. Suzuki et al [ 12 ] reported series of seven patients with ruptured aneurysms.…”

“…Follow-up studies showed spontaneous, complete thrombosis of these aneurysms. Corey et al [ 13 ] reported series of 35 patients, seven of whom presented with ruptured aneurysms. Embolization was immediately successful in all cases, but surgical ligation was required in two cases in the postprocedural period due to rebleeding.…”

Multiple large pancreaticoduodenal artery aneurysms due to celiac artery occlusion: Combination of the aorto-hepatic bypass and coil embolization with a dual approach through both the superior mesenteric artery and bypass

“…Preservation of the hepatic arterial flow is an important issue in coil embolization for aneurysms of the pancreaticoduodenal arcade. However, revascularization of the celiac artery is not required usually, because arterial flow to the liver is maintained through a patent gastroduodenal artery (GDA) [4] . When it is necessary to embolize GDA in the presence of the celiac artery occlusion, revascularization of the celiac artery including aorto-hepatic artery bypass or celiac axis stenting should be considered [4] .…”

“…Treatment for pancreaticoduodenal artery aneurysms is therefore considered appropriate, even in asymptomatic patients. Recently, endovascular management has been considered the first-line treatment because it is highly successful [4] . When embolization of an aneurysm of the pancreaticoduodenal arcade is intended, hepatic artery flow must be preserved [4] .…”

Dual endovascular repair (coils and stent) of a true aneurysm of the gastroduodenal artery

“…These are followed by aneurysms of the hepatic artery (20%); superior mesenteric artery (6%); celiac artery (4%); gastric and gastroepiploic arteries (4%); jejunal, ileal, and colic arteries (3%); pancreaticoduodenal and pancreatic arteries (2%); gastroduodenal artery (GDA) (1.5%); and inferior mesenteric artery, at <1%. 2,3 Despite their low incidence, they should be considered important because they have a disproportionate rupture rate (25%) and significant morbidity and mortality (70%). [4][5][6] Unlike most VAAs, GDA aneurysms tend to be symptomatic.…”