Understanding Vascular Anatomy is Key to Successful Endovascular Treatment of Pancreaticoduodenal Artery Aneurysms

Abstract

Pancreaticoduodenal artery aneurysm (PDAA) is a rare disease without treatment guidelines. We present two patients with PDAA. The first patient was a 70-year-old man with a pseudoaneurysm in the anterior superior pancreaticoduodenal artery (ASPDA), for which we achieved exclusion by endovascular coil embolization. The second patient was a 63-year-old woman with a PDAA in the ASPDA with celiac axis obstruction. Endovascular coil embolization of the aneurysm and the ASPDA was successful without visceral organ ischemia. Endovascular treatment is effective for PDAAs, but careful evaluation of collateral circulation is vital in PDAAs with celiac axis obstruction.

Spontaneous retroperitoneal bleeding secondary to celiac artery compression syndrome

“…Surgical treatment is also indicated when embolization is unsuccessful. Performing surgical ligament release in CACS patients with ruptured aneurysms is not yet established 3,15,16 . Abdominal artery release surgery is expected to improve the symptoms of CACS and prevent subsequent aneurysms, but its long‐term effects are unknown.…”

Endovascular treatment of pancreaticoduodenal aneurysm with braided stent-assisted coil embolization using intraoperative cone-beam computed tomography guidance

“… 2 , 3 Understanding the three-dimensional (3D) morphology of the aneurysm, efferent vessels, and collateral pathways is critical to deciding on the optimal treatment options. 4 This requires better preprocedural 3D planning and/or multiple two-dimensional (2D) angiograms in different C-arm angulations. Intraprocedural 3D imaging techniques such as rotational angiography and cone-beam computed tomography angiography (CBCTA) are routinely performed during neurointerventions for a better understanding of the aneurysm morphology and treatment guidance.…”