scholarly journals A Case of Successful Treatment of Ruptured Pancreaticoduodenal Artery Aneurysm Caused by Celiac Artery Dissection

2018 ◽  
Vol 12 (2) ◽  
pp. 385-389 ◽  
Author(s):  
Naruhiro Kimura ◽  
Atsunori Tsuchiya ◽  
Akihiro Nakamura ◽  
Muneatsu Ueda ◽  
Seiichi Yoshikawa ◽  
...  
Keyword(s):  
Artery Aneurysm ◽  
Celiac Artery ◽  
Artery Dissection ◽  
Angiographic Embolization ◽  
Pancreaticoduodenal Artery ◽  
Contrast Enhanced ◽  
Head Of The Pancreas ◽  
Pancreaticoduodenal Artery Aneurysm ◽  
Enhanced Computed Tomography

A 52-year-old man was admitted due to severe epigastric lesion pain. Esophagus gastroduodenal endoscopy showed impaired duodenal dilatation, and contrast-enhanced computed tomography revealed a pancreaticoduodenal artery (PDA) aneurysm 13 mm in diameter below the head of the pancreas, retroperitoneal hematoma, idiopathic celiac artery (CA) dissection, and common hepatic artery disruption. Angiographic embolization with a mixture of N-butyl-1,2-cyanoacrylate and lipiodol was performed, and follow-up study showed improvement of the dilatation of the duodenum and disappearance of the aneurysm. Here we report a quite rare case of PDA aneurysm by idiopathic dissection of CA treated successfully with angiographic embolization.

Transarterial Embolization With Complementary Surgical Ligation of Gastroduodenal Artery for Ruptured Pancreaticoduodenal Artery Aneurysm

2019 ◽  
Vol 53 (7) ◽  
pp. 593-598 ◽  
Author(s):  
Toru Imagami ◽  
Satoru Takayama ◽  
Taku Hattori ◽  
Ryohei Matsui ◽  
Hisanori Kani ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Transarterial Embolization ◽  
Artery Aneurysm ◽  
Celiac Artery ◽  
Gastroduodenal Artery ◽  
Contrast Enhanced ◽  
Pancreaticoduodenal Artery Aneurysm ◽  
Enhanced Computed Tomography ◽  
Contrast Enhanced Computed Tomography

The association between pancreaticoduodenal artery aneurysm (PDAA) and local hemodynamic changes in pancreaticoduodenal arcades is well established. However, there are few case reports of PDAA associated with acute aortic dissection. In this article, we outline and discuss the case of a 61-year-old man diagnosed with a type A acute aortic dissection who underwent emergency surgery and developed sudden-onset severe abdominal pain and shock 10 days later. Contrast-enhanced computed tomography showed a ruptured PDAA with feeding vessels from the gastroduodenal and superior mesenteric arteries, with evidence that the celiac artery was diverged from a false lumen. Transarterial embolization via the superior mesenteric artery alone was not expected to achieve hemostasis, so we performed a hybrid procedure involving transarterial embolization cannulated from superior mesenteric artery with complementary surgical ligation of the gastroduodenal artery. The postoperative course was uneventful, and follow-up contrast-enhanced computed tomography showed no persistence of the aneurysm 8 days after the second operation. This case proposed that visceral arterial malperfusion due to acute aortic dissection can cause PDAA in the early postoperative period. Although previous reports suggest that endovascular treatment is preferable, it may not always be feasible. Since ruptured PDAAs are often not detected during surgery, surgical treatment can be overly invasive. Whereas, transarterial embolization with complementary clamping or ligation of the gastroduodenal artery for ruptured PDAA is less invasive and can control hemorrhage, especially when cannulation to the celiac artery is impossible. Notably, the technique did not cause organ ischemia, presumably because the small collateral vessels of the pancreaticoduodenal arcades permitted sufficient blood flow. If endovascular treatment is unable to achieve rapid hemostasis, this technique may be a useful option for ruptured PDAA.

Optimal Treatment for Ruptured Pancreaticoduodenal Artery Aneurysm Caused by Celiac Artery Obstruction Due to Celiac Artery Dissection

2018 ◽  
Vol 52 (8) ◽  
pp. 648-652 ◽  
Author(s):  
Hiroyuki Otsuka ◽  
Toshiki Sato ◽  
Hiromichi Aoki ◽  
Yoshihide Nakagawa ◽  
Sadaki Inokuchi
Keyword(s):  
Artery Aneurysm ◽  
Celiac Artery ◽  
Artery Occlusion ◽  
Optimal Treatment ◽  
Artery Dissection ◽  
Pancreaticoduodenal Artery ◽  
Treatment Protocols ◽  
Pancreaticoduodenal Artery Aneurysm ◽  
Flow Through ◽  
Artery Obstruction

A pancreaticoduodenal artery (PDA) aneurysm develops due to increased flow through the pancreaticoduodenal arcade in the setting of celiac or superior mesenteric artery occlusion. Additionally, there is no evidence on the computed tomography scan or angiography images that the dissection process extends to the PDA arcade. Moreover, the optimal treatment protocols for PDA aneurysms with celiac artery obstruction and for celiac artery dissection are controversial. We report 2 cases of ruptured PDA aneurysms caused by celiac artery obstruction due to celiac artery dissection in which the aneurysm was excluded, but celiac artery revascularization was not performed successfully. Our cases indicate that endovascular management for ruptured PDA aneurysms and conservative management for celiac artery obstruction due to celiac artery dissection are feasible as first-line treatment in such cases.

scholarly journals Management of pancreaticoduodenal artery aneurysm associated with coeliac artery stenosis

2019 ◽  
Vol 101 (4) ◽  
pp. e105-e107
Author(s):  
SK Kamarajah ◽  
S Kharkhanis ◽  
M Duddy ◽  
J Isaac ◽  
RP Sutcliffe ◽  
...  
Keyword(s):  
Computed Tomography ◽  
High Risk ◽  
Surgical Intervention ◽  
Artery Aneurysm ◽  
Gastroduodenal Artery ◽  
Pancreaticoduodenal Artery ◽  
Computed Tomography Angiogram ◽  
Pancreaticoduodenal Artery Aneurysm ◽  
Radiological Intervention

Pancreaticoduodenal and gastroduodenal artery aneurysms are rare but require early radiological or surgical intervention due to a high risk (61%) of rupture. A 71-year-old woman presented with an incidental 30-mm aneurysm arising from the inferior pancreaticoduodenal artery associated with coeliac axis stenosis. She underwent embolisation of the pancreaticoduodenal aneurysm, but the coeliac axis stenosis was not amenable to radiological intervention. She remained well at six months of follow-up and a repeat computed tomography angiogram six months later reported stable appearances. The management of pancreaticoduodenal aneurysms is discussed.

A case of small pancreaticoduodenal artery aneurysm diagnosed by contrast-enhanced color Doppler endoscopic ultrasonography

Choonpa Igaku ◽  
2014 ◽  
Vol 41 (1) ◽  
pp. 31-35
Author(s):  
Hiroshi MATSUBARA ◽  
Fumihiro URANO ◽  
Takehito NAITOH ◽  
Motokazu FUJITA ◽  
Masahiro YAMADA ◽  
...  
Keyword(s):  
Endoscopic Ultrasonography ◽  
Color Doppler ◽  
Artery Aneurysm ◽  
Pancreaticoduodenal Artery ◽  
Contrast Enhanced ◽  
Pancreaticoduodenal Artery Aneurysm

scholarly journals A Case of Isolated Celiac Artery Dissection Accompanied by Splenic Infarction Detected by Ultrasonography in the Emergency Department

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Kazumasa Emori ◽  
Nobuhiro Takeuchi ◽  
Junichi Soneda
Keyword(s):  
Emergency Department ◽  
Celiac Artery ◽  
Splenic Infarction ◽  
Artery Dissection ◽  
Emergency Setting ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
History Of ◽  
Enhanced Computed Tomography

A 46-year-old male with a history of hypertension visited the emergency department (ED) by ambulance complaining of sudden pain in the left side of his back. Ultrasonography (USG) performed at ED revealed splenic infarction along with occlusion and dissection of the celiac and splenic arteries without abdominal artery dissection. Contrast enhanced computed tomography (CT) revealed the same result. Consequently, spontaneous isolated celiac artery dissection (SICAD) was diagnosed. Because his blood pressure was high (159/70 mmHg), antihypertensive medicine was administered (nicardipine and carvedilol). After his blood reached optimal levels (130/80 mmHg), symptoms disappeared. Follow-up USG and contrast enhanced CT performed 8 days and 4 months after onset revealed amelioration of splenic infarction and improvement of the narrowed artery. Here, we report a case of SICAD with splenic infarction presenting with severe left-sided back pain and discuss the relevance of USG in an emergency setting.

Effectiveness of the conservative therapy for spontaneous isolated iliac artery dissection: Preliminary results

Vascular ◽  
2017 ◽  
Vol 25 (6) ◽  
pp. 649-656 ◽  
Author(s):  
Zhuhong Liang ◽  
Weiwei Guo ◽  
Chunhua Du ◽  
Yingdi Xie
Keyword(s):  
Computed Tomography ◽  
Conservative Therapy ◽  
False Lumen ◽  
Artery Dissection ◽  
True Lumen ◽  
Contrast Enhanced ◽  
Entry Points ◽  
Enhanced Computed Tomography ◽  
Contrast Enhanced Computed Tomography

Purpose To investigate the effectiveness of conservative therapy for spontaneous isolated iliac artery dissection (SIIAD). Methods From February 2006 to May 2016, all patients with SIIAD were included and analyzed. The diagnosis of SIIAD was made based on contrast-enhanced computed tomography. The imaging morphologic characteristics, treatments, and outcomes for each patient were analyzed. Results A total of 11 patients (10 male and 1 female, age 71.1 ± 7.8 years) were included in this study. Of the 11 patients, 8 patients were asymptomatic and the SIIADs were discovered during the course of computed tomography for other diseases, and 3 patients were symptomatic. Initial computed tomography findings: iliac arterial calcification ( n = 7); compression of the true lumen ( n = 6), with stenosis of the true lumen from 25% to 50% ( n = 3) and ≥ 50% ( n = 3); thrombosed false lumen partially ( n = 4), and no thrombosis in false lumen ( n = 7); dissecting aneurysm ( n = 11); entry points ( n = 11); re-entry points ( n = 1); no dissection extended to the internal iliac or common femoral artery. Conservative treatment was performed in six patients, and the remaining five patients need no treatment. During 23.3 ± 14.2 months follow-up, none recurred symptoms and signs of symptomatic SIIAD; partial remodeling of SIIAD was achieved in four patients, and the remaining seven patients with no change of SIIAD. There was no presence of new false lumen enhancement on contrast-enhanced computed tomography during follow-up. Conclusions SIIAD without arterial rupture or lower limb necrosis can be safely treated with conservative therapy.

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