Semin intervent Radiol 2009; 26(3): 215-223
DOI: 10.1055/s-0029-1225671
© Thieme Medical Publishers

Inferior Pancreaticoduodenal Artery Aneurysms in Association with Celiac Stenosis/Occlusion

Rekha Kallamadi1 , 3 , Marc A. deMoya2 , 3 , Sanjeeva P. Kalva1 , 3
  • 1Department of Radiology (Division of Cardiovascular Imaging and Intervention), Harvard Medical School, Boston, Massachusetts
  • 2Department of Surgery (Division of Trauma, Emergency Surgery, Surgical Critical Care), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
  • 3Harvard Medical School, Boston, Massachusetts
Further Information

Publication History

Publication Date:
12 August 2009 (online)

ABSTRACT

Inferior pancreaticoduodenal artery aneurysms in association with celiac stenosis or occlusion are well described in the literature. These aneurysms are true aneurysms and develop as a result of increased flow through the pancreaticoduodenal arcades in the presence of hemodynamically significant stenosis of the celiac axis or common hepatic artery. Aneurysms may be multiple and rarely associated with aneurysms in other collateral pathways—such as the dorsal pancreatic artery or the arc of Buhler. These aneurysms may be incidentally detected or patients may present with abdominal pain or shock secondary to rupture of the aneurysms. Treatment options include surgical resection and transcatheter embolization; current literature favors the latter option. Treatment of celiac axis stenosis may be recommended in addition to treating the aneurysms; however, no formal guidelines exist on this recommendation.

REFERENCES

  • 1 Ferguson F. Aneurysm of the superior pancreaticoduodenal artery. Proceedings of the New York Pathological Society 1895: 24
  • 2 Williams M, Alderson D, Virjee J, Callaway M. CT-guided percutaneous thrombin injection for treatment of an inferior pancreaticoduodenal artery pseudoaneurysm.  Cardiovasc Intervent Radiol. 2006;  29(4) 669-671
  • 3 Sato N, Yamaguchi K, Shimizu S et al.. Coil embolization of bleeding visceral pseudoaneurysms following pancreatectomy: the importance of early angiography.  Arch Surg. 1998;  133(10) 1099-1102
  • 4 Bratby M J, Lehmann E D, Bottomley J et al.. Endovascular embolization of visceral artery aneurysms with ethylene-vinyl alcohol (Onyx): a case series.  Cardiovasc Intervent Radiol. 2006;  29(6) 1125-1128
  • 5 Takeuchi H, Isobe Y, Hayashi M et al.. Ruptured pancreaticoduodenal artery aneurysm with acute gangrenous cholecystitis: a case report and review of the literature.  Hepatogastroenterology. 2004;  51(56) 368-371
  • 6 Stanley J C, Wakefield T W, Graham L M, Whitehouse Jr W M, Zelenock G B, Lindenauer S M. Clinical importance and management of splanchnic artery aneurysms.  J Vasc Surg. 1986;  3(5) 836-840
  • 7 Imamura M, Shiiya N, Murashita T, Sasaki S, Matsui Y, Yasuda K. Pancreaticoduodenal artery aneurysm with celiac trunk occlusion. Report of a case.  J Cardiovasc Surg (Torino). 1998;  39(5) 565-567
  • 8 Chiou A C, Josephs L G, Menzoian J O. Inferior pancreaticoduodenal artery aneurysm: report of a case and review of the literature.  J Vasc Surg. 1993;  17(4) 784-789
  • 9 American College of Surgeons Committee on Trauma .Shock. In: American College of Surgeons Committee on Trauma Advanced Trauma Life Support Program for Doctors. Chicago, IL; The American College of Surgeons 1997: 87-107
  • 10 Tori M, Nakahara M, Akamatsu H, Ueshima S, Shimizu M, Nakao K. Significance of intraoperative monitoring of arterial blood flow velocity and hepatic venous oxygen saturation for performing minimally invasive surgery in a patient with multiple calcified pancreaticoduodenal aneurysms with celiac artery occlusion.  J Hepatobiliary Pancreat Surg. 2006;  13(5) 472-476
  • 11 Sutton D, Lawton G. Coeliac stenosis or occlusion with aneurysm of the collateral supply.  Clin Radiol. 1973;  24(1) 49-53
  • 12 Kadir S, Athanasoulis C A, Yune H Y, Wilkov H. Aneurysms of the pancreaticoduodenal arteries in association with celiac axis occlusion.  Cardiovasc Radiol. 1978;  1(3) 173-177
  • 13 Ogino H, Sato Y, Banno T, Arakawa T, Hara M. Embolization in a patient with ruptured anterior inferior pancreaticoduodenal arterial aneurysm with median arcuate ligament syndrome.  Cardiovasc Intervent Radiol. 2002;  25(4) 318-319
  • 14 Suzuki K, Kashimura H, Sato M et al.. Pancreaticoduodenal artery aneurysms associated with celiac axis stenosis due to compression by median arcuate ligament and celiac plexus.  J Gastroenterol. 1998;  33(3) 434-438
  • 15 Ducasse E, Roy F, Chevalier J et al.. Aneurysm of the pancreaticoduodenal arteries with a celiac trunk lesion: current management.  J Vasc Surg. 2004;  39(4) 906-911
  • 16 Akatsu T, Hayashi S, Yamane T, Yoshii H, Kitajima M. Emergency embolization of a ruptured pancreaticoduodenal artery aneurysm associated with the median arcuate ligament syndrome.  J Gastroenterol Hepatol. 2004;  19(4) 482-483
  • 17 Sugiyama K, Takehara Y. Analysis of five cases of splanchnic artery aneurysm associated with coeliac artery stenosis due to compression by the median arcuate ligament.  Clin Radiol. 2007;  62(7) 688-693
  • 18 Ignashov A M, Grinev K M, Kanaev A I, Perle V E, Petrova S N. [Aneurysms of the pancreaticoduodenal artery in association with stenosis or occlusion of the celiac trunk].  Vestn Khir Im I I Grek. 2005;  164(1) 105-110
  • 19 Tarazov P G, Ignashov A M, Pavlovskij A V, Novikova A S. Pancreaticoduodenal artery aneurysm associated with celiac axis stenosis: combined angiographic and surgical treatment.  Dig Dis Sci. 2001;  46(6) 1232-1235
  • 20 Ikeda O, Tamura Y, Nakasone Y, Kawanaka K, Yamashita Y. Coil embolization of pancreaticoduodenal artery aneurysms associated with celiac artery stenosis: report of three cases.  Cardiovasc Intervent Radiol. 2007;  30(3) 504-507
  • 21 Porcellini M, Iaccarino V, Bernardo B, Migliucci N, Capasso R. Visceral artery aneurysms secondary to collateral circulation.  Minerva Cardioangiol. 1996;  44(9) 443-445
  • 22 Song S Y, Chung J W, Kwon J W et al.. Collateral pathways in patients with celiac axis stenosis: angiographic-spiral CT correlation.  Radiographics. 2002;  22(4) 881-893
  • 23 Grabbe E, Bücheler E. [Bühler's anastomosis (author's transl).  Rofo. 1980;  132(5) 541-546
  • 24 Lin P H, Chaikof E L. Embryology, anatomy, and surgical exposure of the great abdominal vessels.  Surg Clin North Am. 2000;  80(1) 417-433, xiv
  • 25 Kobayashi T, Uenoyama S, Isogai S. Successful transcatheter arterial embolization of an inferior pancreaticoduodenal artery aneurysm associated with celiac axis stenosis.  J Gastroenterol Hepatol. 2004;  19(5) 599-601
  • 26 Hildebrand P, Esnaashari H, Franke C, Bürk C, Bruch H P. Surgical management of pancreaticoduodenal artery aneurysms in association with celiac trunk occlusion or stenosis.  Ann Vasc Surg. 2007;  21(1) 10-15
  • 27 Bageacu S, Cuilleron M, Kaczmarek D, Porcheron J. True aneurysms of the pancreaticoduodenal artery: successful non-operative management.  Surgery. 2006;  139(5) 608-616
  • 28 Bellosta R, Luzzani L, Carugati C, Melloni C, Sarcina A. Pancreaticoduodenal artery aneurysms associated with celiac axis occlusion.  Ann Vasc Surg. 2005;  19(4) 534-539
  • 29 Calkins C M, Moore E E, Turner J, Cothren C, Burch J M. Combined modality treatment of ruptured pancreaticoduodenal artery aneurysms due to celiac artery compression.  Surgery. 2004;  136(5) 1088-1089
  • 30 Shibata T, Fujimoto Y, Jin M J, Hiraoka M. Transcatheter arterial embolization for large pancreaticoduodenal artery aneurysm with mechanically detachable coils.  Cardiovasc Intervent Radiol. 2004;  27(2) 169-171
  • 31 Guijt M, van Delden O M, Koedam N A, van Keulen E, Reekers J A. Rupture of true aneurysms of the pancreaticoduodenal arcade: treatment with transcatheter arterial embolization.  Cardiovasc Intervent Radiol. 2004;  27(2) 166-168
  • 32 Tien Y W, Kao H L, Wang H P. Celiac artery stenting: a new strategy for patients with pancreaticoduodenal artery aneurysm associated with stenosis of the celiac artery.  J Gastroenterol. 2004;  39(1) 81-85
  • 33 Peterson B G, Resnick S A, Eskandari M K. Coil embolization of an inferior pancreaticoduodenal artery aneurysm associated with celiac artery occlusion.  Cardiovasc Surg. 2003;  11(6) 515-519
  • 34 Uher P, Nyman U, Ivancev K, Lindh M. Aneurysms of the pancreaticoduodenal artery associated with occlusion of the celiac artery.  Abdom Imaging. 1995;  20(5) 470-473
  • 35 Lossing A G, Grosman H, Mustard R A, Hatswell E M. Emergency embolization of a ruptured aneurysm of the pancreaticoduodenal arcade.  Can J Surg. 1995;  38(4) 363-365
  • 36 Chiang K S, Johnson C M, McKusick M A, Maus T P, Stanson A W. Management of inferior pancreaticoduodenal artery aneurysms: a 4-year, single center experience.  Cardiovasc Intervent Radiol. 1994;  17(4) 217-221
  • 37 Grech P, Rowlands P, Crofton M. Aneurysm of the inferior pancreaticoduodenal artery diagnosed by real-time ultrasound and pulsed Doppler.  Br J Radiol. 1989;  62(740) 753-755
  • 38 Widjaja A, Rosenthal H, Bleck J et al.. Pitfall: a pseudo tumor within the left liver lobe presenting with abdominal pain, jaundice and severe weight loss.  Ultraschall Med. 1999;  20(6) 268-272
  • 39 Horiguchi A, Ishihara S, Ito M et al.. Multislice CT study of pancreatic head arterial dominance.  J Hepatobiliary Pancreat Surg. 2008;  15(3) 322-326
  • 40 Williams M, Alderson D, Virjee J, Callaway M. CT-guided percutaneous thrombin injection for treatment of an inferior pancreaticoduodenal artery pseudoaneurysm.  Cardiovasc Intervent Radiol. 2006;  29(4) 669-671
  • 41 Paty P S, Cordero Jr J A, Darling III R C, Chang B B, Shah D M, Leather R P. Aneurysms of the pancreaticoduodenal artery.  J Vasc Surg. 1996;  23(4) 710-713

Sanjeeva P KalvaM.D. 

Department of Radiology (Division of Cardiovascular Imaging and Intervention)

55 Fruit Street, GRB-290, Boston, MA 02114

Email: skalva@partners.org

    >