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Pancreaticoduodenal artery aneurysms secondary to median arcuate ligament syndrome may not need celiac artery revascularization or ligament release
- Source :
- Annals of vascular surgery. 29(1)
- Publication Year :
- 2014
-
Abstract
- Introduction Median arcuate ligament syndrome (MALS) is a rare disorder defined by compression and narrowing of the celiac artery by the median arcuate ligament. The increased blood flow through the pancreaticoduodenal arcade can lead to the aneurysmal formation within the vessel. We report 3 cases of pancreaticoduodenal arterial aneurysms (PDAAs) in patients with MALS whose aneurysms were occluded, but celiac artery revascularization was not performed. Methods Case 1: Asymptomatic 61-year-old female with no past medical history was referred to vascular surgery for evaluation of a PDAA incidentally found on computed tomography (CT) scan. The patient was taken for laparoscopic division of the median arcuate ligament; however, the release was incomplete. This was followed by endovascular coil embolization of the PDAA without celiac revascularization. The patient tolerated the procedure well with no complications and the 1-year follow-up shows no signs of aneurysm recurrence. Case 2: A 61-year-old male found to have an incidental PDAA on CT scan. The patient was taken for coil embolization without median arcuate ligament release. At the 1-year follow-up, the patient continues to be asymptomatic with no recurrence. Case 3: A 56-year-old male presented with a ruptured PDAA. He was taken immediately for coil embolization of the ruptured aneurysm. Postoperatively, the patient was identified to have MALS on CT scan. Because of his asymptomatic history and benign physical examination before the rupture, he was not taken for a ligament release or celiac revascularization. He continues to be asymptomatic at his follow-up. Results PDAAs secondary to MALS are very rare and most commonly diagnosed at the time of rupture, which has a mortality rate that reaches approximately 30%, making early identification and treatment necessary. Standard treatment would include exclusion of the aneurysm followed by celiac revascularization; however, these 3 cases identify an alternative approach to the standard treatment. Conclusion Celiac revascularization may not be necessary in the asymptomatic patient with a PDAA who has close follow-up and serial imaging.
- Subjects :
- Male
medicine.medical_specialty
Time Factors
Duodenum
medicine.medical_treatment
Constriction, Pathologic
Aneurysm, Ruptured
Revascularization
Asymptomatic
Aneurysm
Median Arcuate Ligament Syndrome
Celiac artery
Celiac Artery
medicine.artery
Medicine
Humans
Embolization
Splanchnic Circulation
Pancreas
Past medical history
business.industry
Median arcuate ligament
Hemodynamics
General Medicine
Middle Aged
medicine.disease
Decompression, Surgical
Embolization, Therapeutic
Surgery
medicine.anatomical_structure
Treatment Outcome
Female
Radiology
medicine.symptom
Cardiology and Cardiovascular Medicine
business
Tomography, X-Ray Computed
Median arcuate ligament syndrome
Subjects
Details
- ISSN :
- 16155947
- Volume :
- 29
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Annals of vascular surgery
- Accession number :
- edsair.doi.dedup.....b0fb5062800eea1a3dc47207ab521cd9