Back to Search Start Over

Combined treatment of an aortosplenic bypass followed by coil embolization in the treatment of pancreaticoduodenal artery aneurysms caused by median arcuate ligament compression: a report of two cases

Authors :
Shuhei Kii
Hirofumi Kamachi
Daisuke Abo
Takuya Kato
Yousuke Tsuruga
Kenji Wakayama
Tatsuhiko Kakisaka
Takeshi Soyama
Toshiya Kamiyama
Tomonori Ooka
Satoru Wakasa
Akinobu Taketomi
Source :
Surgical Case Reports, Vol 7, Iss 1, Pp 1-9 (2021)
Publication Year :
2021
Publisher :
SpringerOpen, 2021.

Abstract

Abstract Background Pancreaticoduodenal artery aneurysms (PDAAs) are rare visceral aneurysms, and prompt intervention/treatment of all PDAAs is recommended at the time of diagnosis to avoid rupture of aneurysms. Herein, we report two cases of PDAA caused by the median arcuate ligament syndrome, treated with surgical revascularization by aortosplenic bypass followed by coil embolization. Case presentation Case 1 A 54-year-old woman presented with a chief complaint of severe epigastralgia and was diagnosed with two large fusiform inferior PDAAs and celiac axis occlusion. To preserve the blood flow of the pancreatic head, duodenum, liver, and spleen, we performed elective surgery to release the MAL along with aortosplenic bypass. At 6 days postoperatively, transcatheter arterial embolization was performed. At the 8-year 6-month follow-up observation, no recurrent perfusion of the embolized PDAAs or rupture had occurred, including the non-embolized small PDAA, and the bypass graft had excellent patency. Case 2 A 39-year-old man who had been in good health was found to have a PDAA with celiac stenosis during a medical checkup. Computed tomography and superior mesenteric arteriography showed severe celiac axis stenosis and a markedly dilated pancreatic arcade with a large saccular PDAA. To preserve the blood flow of the pancreatic arcade, we performed elective surgery to release the MAL along with aortosplenic bypass. At 9 days postoperatively, transcatheter arterial embolization was performed. At the 6-year 7-month follow-up observation, no recurrent perfusion or rupture of the PDAA had occurred, and the bypass graft had excellent patency. Conclusion Combined treatment with bypass surgery and coil embolization can be an effective option for the treatment of PDAAs associated with celiac axis occlusion or severe stenosis.

Details

Language :
English
ISSN :
21987793
Volume :
7
Issue :
1
Database :
Directory of Open Access Journals
Journal :
Surgical Case Reports
Publication Type :
Academic Journal
Accession number :
edsdoj.f2fd46ef8d44fe0960e6872ff9d76ae
Document Type :
article
Full Text :
https://doi.org/10.1186/s40792-021-01260-1