Treatment strategies for unruptured pancreaticoduodenal artery aneurysms associated with celiac artery occlusion
Abstract Celiac artery (CA) occlusion or stenosis is identified in up to almost half of all patients undergoing abdominal angiography, and the resulting increased collateral blood flow from the superior mesenteric artery to the pancreaticoduodenal artery (PDA) may cause PDA aneurysms (PDAAs). PDAAs...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-01-01
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| Series: | Annals of Gastroenterological Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ags3.12609 |
| _version_ | 1797956342221111296 |
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| author | Koji Kubota Akira Shimizu Tsuyoshi Notake Yuko Wada Yuji Soejima |
| author_facet | Koji Kubota Akira Shimizu Tsuyoshi Notake Yuko Wada Yuji Soejima |
| author_sort | Koji Kubota |
| collection | DOAJ |
| description | Abstract Celiac artery (CA) occlusion or stenosis is identified in up to almost half of all patients undergoing abdominal angiography, and the resulting increased collateral blood flow from the superior mesenteric artery to the pancreaticoduodenal artery (PDA) may cause PDA aneurysms (PDAAs). PDAAs are rare but could be fatal if they rupture. However, treatment of the PDAA could block this important collateral blood flow pathway, leading to ischemic organ damage. Treatment of such aneurysms is therefore difficult, especially in patients with multiple PDAAs. Successful treatment of PDAAs requires establishing blood flow in the CA region and selecting which aneurysm(s) to treat. We present four patients who underwent surgery for unruptured PDAAs caused by CA obstruction. Blood flow in the CA region was established by bypassing the splenic artery and by anastomosing it either directly to the left renal artery (n = 1) or to the abdominal aorta using a graft (saphenous vein: n = 1; artificial vessel: n = 2). Three patients had multiple PDAAs: all PDAAs were treated in one patient with PDAAs of similar size and shape, but only the largest PDAA with the highest risk of rupture was treated in the other two patients to simplify the procedure. The median observation period was 19.5 months (range: 11‐28 months), and all patients were alive without recurrence at the time of writing. Surgical treatment including splenic artery bypass may thus be a viable option for treating patients with unruptured PDAAs. |
| first_indexed | 2024-04-10T23:47:26Z |
| format | Article |
| id | doaj.art-e3067c16395f492491047a872d2e4590 |
| institution | Directory Open Access Journal |
| issn | 2475-0328 |
| language | English |
| last_indexed | 2024-04-10T23:47:26Z |
| publishDate | 2023-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Annals of Gastroenterological Surgery |
| spelling | doaj.art-e3067c16395f492491047a872d2e45902023-01-11T02:40:42ZengWileyAnnals of Gastroenterological Surgery2475-03282023-01-017118218910.1002/ags3.12609Treatment strategies for unruptured pancreaticoduodenal artery aneurysms associated with celiac artery occlusionKoji Kubota0Akira Shimizu1Tsuyoshi Notake2Yuko Wada3Yuji Soejima4Division of Gastroenterological, Hepato‐Biliary‐Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery Shinshu University School of Medicine Matsumoto JapanDivision of Gastroenterological, Hepato‐Biliary‐Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery Shinshu University School of Medicine Matsumoto JapanDivision of Gastroenterological, Hepato‐Biliary‐Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery Shinshu University School of Medicine Matsumoto JapanDivision of Cardiovascular Surgery, Department of Surgery Shinshu University School of Medicine Matsumoto JapanDivision of Gastroenterological, Hepato‐Biliary‐Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery Shinshu University School of Medicine Matsumoto JapanAbstract Celiac artery (CA) occlusion or stenosis is identified in up to almost half of all patients undergoing abdominal angiography, and the resulting increased collateral blood flow from the superior mesenteric artery to the pancreaticoduodenal artery (PDA) may cause PDA aneurysms (PDAAs). PDAAs are rare but could be fatal if they rupture. However, treatment of the PDAA could block this important collateral blood flow pathway, leading to ischemic organ damage. Treatment of such aneurysms is therefore difficult, especially in patients with multiple PDAAs. Successful treatment of PDAAs requires establishing blood flow in the CA region and selecting which aneurysm(s) to treat. We present four patients who underwent surgery for unruptured PDAAs caused by CA obstruction. Blood flow in the CA region was established by bypassing the splenic artery and by anastomosing it either directly to the left renal artery (n = 1) or to the abdominal aorta using a graft (saphenous vein: n = 1; artificial vessel: n = 2). Three patients had multiple PDAAs: all PDAAs were treated in one patient with PDAAs of similar size and shape, but only the largest PDAA with the highest risk of rupture was treated in the other two patients to simplify the procedure. The median observation period was 19.5 months (range: 11‐28 months), and all patients were alive without recurrence at the time of writing. Surgical treatment including splenic artery bypass may thus be a viable option for treating patients with unruptured PDAAs.https://doi.org/10.1002/ags3.12609celiac artery obstructionpancreaticoduodenal arcadepancreaticoduodenal artery aneurysmreconstructionsplenic artery bypass |
| spellingShingle | Koji Kubota Akira Shimizu Tsuyoshi Notake Yuko Wada Yuji Soejima Treatment strategies for unruptured pancreaticoduodenal artery aneurysms associated with celiac artery occlusion Annals of Gastroenterological Surgery celiac artery obstruction pancreaticoduodenal arcade pancreaticoduodenal artery aneurysm reconstruction splenic artery bypass |
| title | Treatment strategies for unruptured pancreaticoduodenal artery aneurysms associated with celiac artery occlusion |
| title_full | Treatment strategies for unruptured pancreaticoduodenal artery aneurysms associated with celiac artery occlusion |
| title_fullStr | Treatment strategies for unruptured pancreaticoduodenal artery aneurysms associated with celiac artery occlusion |
| title_full_unstemmed | Treatment strategies for unruptured pancreaticoduodenal artery aneurysms associated with celiac artery occlusion |
| title_short | Treatment strategies for unruptured pancreaticoduodenal artery aneurysms associated with celiac artery occlusion |
| title_sort | treatment strategies for unruptured pancreaticoduodenal artery aneurysms associated with celiac artery occlusion |
| topic | celiac artery obstruction pancreaticoduodenal arcade pancreaticoduodenal artery aneurysm reconstruction splenic artery bypass |
| url | https://doi.org/10.1002/ags3.12609 |
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