Search

To describe the presentation, treatment, and outcomes for 14 patients with aneurysms of the inferior pancreaticoduodenal arteries associated with occlusive lesions of the celiac axis, and to review the literature for similar cases. Over a period of 12 years, 14 patients (10 women and 4 men) ranging in age from 26 to 50 (mean 46) years were demonstrated to have aneurysms of the inferior pancreaticoduodenal artery origin associated with stenosis or occlusion of the celiac axis. All patients were treated by a combination of surgery and interventional radiology. Outcome data collected between 3 months and 4 years (mean 2 years) demonstrated that all aneurysms remained excluded, and all 14 patients were well. The 49 case reports in the literature confirm the findings of this cohort. In inferior pancreaticoduodenal artery aneurysm resulting from celiac occlusive disease, endovascular treatment is best achieved by stenting the celiac axis and/or embolizing the aneurysm when necessary.

We report the application of the liquid embolic agent ethylene-vinyl alcohol (Onyx; MicroTherapeutics, Irvine, CA, USA) in the management of visceral artery aneurysms. The technique and indications for using Onyx are discussed with emphasis on the management of wide-necked aneurysms and maintenance of patency of the parent vessel. None of the cases was considered suitable for stent-grafting or embolization with conventional agents. Two aneurysms of the renal artery bifurcation and one aneurysm of the inferior pancreaticoduodenal artery were treated. Following treatment there was complete exclusion of all aneurysms. There was no evidence of end-organ infarction. Follow-up with intervals up to 6 months has shown sustained aneurysm exclusion. Onyx is known to be effective in the management of intracranial aneurysms. Our experience demonstrates the efficacy and applicability of the use of Onyx in the treatment of complex visceral artery aneurysms.

We present a case of an inferior pancreaticoduodenal artery pseudoaneurysm treated by computed tomography (CT)-guided percutaneous injection of thrombin. As far as we are aware, we present the first documented case of successful long-term (9 months) follow-up with no evidence of recurrence.

Although aneurysmal complications of sickle cell anemia have been described in the intracranial circulation, visceral artery pseudoaneurysms in this disease entity have not previously been reported in the literature. Conventional treatment of visceral pseudoaneurysms has been surgical ligation or resection of the aneurysm. Transcatheter embolization has emerged as an attractive, minimally invasive alternative to surgery in the treatment of these lesions. In certain situations, however, due to the unfavorable angiographic anatomy precluding safe transcatheter embolization, direct percutaneous glue injection of the pseudoaneurysm sac may be considered to achieve successful occlusion of the sac. The procedure may be rendered safer by simultaneous balloon protection of the parent artery. We describe this novel treatment modality in a case of inferior pancreaticoduodenal artery pseudoaneurysm in a patient with sickle cell anemia. Although a complication in the form of glue reflux into the parent vessel occurred that necessitated surgery, this treatment modality may be used in very selected cases (where conventional endovascular embolization techniques are not applicable) after careful selection of the balloon diameter and appropriate concentration of the glue-lipiodol mixture.

Large aneurysms (5.5 and 3.6 cm in diameter) arising from the inferior pancreaticoduodenal artery located just near the main superior mesenteric artery were incidentally diagnosed in two patients. Transcatheter arterial embolization, packing mechanically detachable coils and microcoils into the aneurysms, was performed while the inflated balloon catheter was placed near the neck of the aneurysms. The procedures were successfully performed and no aneurysmal rupture or bowel ischemia was noted during follow-up. Balloon-assisted transcatheter arterial embolization with mechanically detachable coils seems to be an effective and safe treatment for large inferior pancreaticoduodenal aneurysms.

Inferior pancreaticoduodenal artery aneurysms are uncommon visceral artery aneurysms usually difficult to resect, and, if untreated, have a propensity to rupture with catastrophic results. We reviewed the clinical and treatment records of four patients encountered in our institution within the last 4 years. Three patients presented as bleeding emergencies from single aneurysms and were successfully treated by transcatheter embolization using coaxial technique and a variety of embolic agents. One nonemergent, asymptomatic patient had surgical resection of two inferior pancreaticoduodenal artery aneurysms due to unfavorable anatomy for embolization. Embolization therapy appears to be the treatment of choice in the emergency setting. Patients with unsuitable anatomy for embolization may still re quire surgical intervention.