Hemodynamic benefits of celiac artery release for ruptured right gastric artery aneurysm associated with median arcuate ligament syndrome: a case report
Abstract Background It has been reported that median arcuate ligament syndrome is closely associated with gastric or pancreaticoduodenal artery aneurysms. Hemodynamic state plays an important role in the formation of the aneurysms. These aneurysms are treated with open resection or endovascular excl...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2017-11-01
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| Series: | BMC Surgery |
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| Online Access: | http://link.springer.com/article/10.1186/s12893-017-0320-0 |
| _version_ | 1819076115095879680 |
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| author | Tetsuro Toriumi Takuro Shirasu Atsushi Akai Yuichi Ohashi Takatoshi Furuya Yukihiro Nomura |
| author_facet | Tetsuro Toriumi Takuro Shirasu Atsushi Akai Yuichi Ohashi Takatoshi Furuya Yukihiro Nomura |
| author_sort | Tetsuro Toriumi |
| collection | DOAJ |
| description | Abstract Background It has been reported that median arcuate ligament syndrome is closely associated with gastric or pancreaticoduodenal artery aneurysms. Hemodynamic state plays an important role in the formation of the aneurysms. These aneurysms are treated with open resection or endovascular exclusion. However, whether revascularization of the celiac artery can prevent the aneurysm formation is unknown. This report indicated a possibility that prophylactic revascularization for celiac artery stenosis resulted in decreased shear stress on the collaterals, which may otherwise be susceptible to new aneurysms. Case presentation This report describes a 51-year-old man who presented with epigastric pain at our hospital. According to contrast enhanced computed tomography (CT), he was diagnosed with a ruptured right gastric artery aneurysm and celiac artery stenosis caused by the median arcuate ligament (MAL). He had a vascular anomaly of the common hepatic artery arising from the superior mesenteric artery (SMA). His vital signs were stable. We informed him of the situation and he chose open surgery rather than endovascular treatment. Following, we resected the aneurysm and transected the MAL. Intraoperative angiography after transection of the MAL showed the antegrade blood flow to the splenic artery instead of the retrograde flow via the prominent collaterals. Follow-up CT confirmed narrowed collateral vessels between the SMA and the celiac artery without de-novo aneurysms. Conclusion While the necessity of celiac artery release could be questioned, the present case supports the hemodynamic benefits of MAL transection in terms of de-novo aneurysm prevention. |
| first_indexed | 2024-12-21T18:36:10Z |
| format | Article |
| id | doaj.art-d6ce6aa2f3aa4d8cbd12e6f9b185e232 |
| institution | Directory Open Access Journal |
| issn | 1471-2482 |
| language | English |
| last_indexed | 2024-12-21T18:36:10Z |
| publishDate | 2017-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Surgery |
| spelling | doaj.art-d6ce6aa2f3aa4d8cbd12e6f9b185e2322022-12-21T18:54:08ZengBMCBMC Surgery1471-24822017-11-011711510.1186/s12893-017-0320-0Hemodynamic benefits of celiac artery release for ruptured right gastric artery aneurysm associated with median arcuate ligament syndrome: a case reportTetsuro Toriumi0Takuro Shirasu1Atsushi Akai2Yuichi Ohashi3Takatoshi Furuya4Yukihiro Nomura5Department of Surgery, Asahi General HospitalDepartment of Surgery, Asahi General HospitalDivision of Vascular Surgery, Department of Surgery, The University of TokyoDivision of Vascular Surgery, Department of Surgery, The University of TokyoDepartment of Surgery, Asahi General HospitalDepartment of Surgery, Asahi General HospitalAbstract Background It has been reported that median arcuate ligament syndrome is closely associated with gastric or pancreaticoduodenal artery aneurysms. Hemodynamic state plays an important role in the formation of the aneurysms. These aneurysms are treated with open resection or endovascular exclusion. However, whether revascularization of the celiac artery can prevent the aneurysm formation is unknown. This report indicated a possibility that prophylactic revascularization for celiac artery stenosis resulted in decreased shear stress on the collaterals, which may otherwise be susceptible to new aneurysms. Case presentation This report describes a 51-year-old man who presented with epigastric pain at our hospital. According to contrast enhanced computed tomography (CT), he was diagnosed with a ruptured right gastric artery aneurysm and celiac artery stenosis caused by the median arcuate ligament (MAL). He had a vascular anomaly of the common hepatic artery arising from the superior mesenteric artery (SMA). His vital signs were stable. We informed him of the situation and he chose open surgery rather than endovascular treatment. Following, we resected the aneurysm and transected the MAL. Intraoperative angiography after transection of the MAL showed the antegrade blood flow to the splenic artery instead of the retrograde flow via the prominent collaterals. Follow-up CT confirmed narrowed collateral vessels between the SMA and the celiac artery without de-novo aneurysms. Conclusion While the necessity of celiac artery release could be questioned, the present case supports the hemodynamic benefits of MAL transection in terms of de-novo aneurysm prevention.http://link.springer.com/article/10.1186/s12893-017-0320-0Median arcuate ligament syndromeRight gastric artery aneurysmPancreaticoduodenal artery aneurysmShear stress |
| spellingShingle | Tetsuro Toriumi Takuro Shirasu Atsushi Akai Yuichi Ohashi Takatoshi Furuya Yukihiro Nomura Hemodynamic benefits of celiac artery release for ruptured right gastric artery aneurysm associated with median arcuate ligament syndrome: a case report BMC Surgery Median arcuate ligament syndrome Right gastric artery aneurysm Pancreaticoduodenal artery aneurysm Shear stress |
| title | Hemodynamic benefits of celiac artery release for ruptured right gastric artery aneurysm associated with median arcuate ligament syndrome: a case report |
| title_full | Hemodynamic benefits of celiac artery release for ruptured right gastric artery aneurysm associated with median arcuate ligament syndrome: a case report |
| title_fullStr | Hemodynamic benefits of celiac artery release for ruptured right gastric artery aneurysm associated with median arcuate ligament syndrome: a case report |
| title_full_unstemmed | Hemodynamic benefits of celiac artery release for ruptured right gastric artery aneurysm associated with median arcuate ligament syndrome: a case report |
| title_short | Hemodynamic benefits of celiac artery release for ruptured right gastric artery aneurysm associated with median arcuate ligament syndrome: a case report |
| title_sort | hemodynamic benefits of celiac artery release for ruptured right gastric artery aneurysm associated with median arcuate ligament syndrome a case report |
| topic | Median arcuate ligament syndrome Right gastric artery aneurysm Pancreaticoduodenal artery aneurysm Shear stress |
| url | http://link.springer.com/article/10.1186/s12893-017-0320-0 |
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