Abstract:Objective: To investigate the treatment timing and method for pancreaticoduodenal artery aneurysm (PDAA) accompanied with celiac axis stenosis.
Methods: The clinical data of 6 patients with PDAA were retrospectively analyzed. Diagnosis was made in 4 patients due to aneurysm rupture/bleeding and in 2 patients by accident. All the 6 patients had a concomitant celiac axis stenosis or occlusion, and all of them underwent endovascular aneurysm embolization.
Results: Of the 6 patients, 5 cases were males and one case was female, whose age ranged from 42 to 81 years, with an average age of 59.8 years; the aneurysm size ranged from 8 to 21 mm, with an average of 14.6 mm; 2 cases had a true aneurysm and 4 cases had a pseudoaneurysms; the lesion was located in the posterior inferior pancreaticoduodenal artery in 4 cases, and in the anterior inferior pancreaticoduodenal artery in 2 cases; 5 patients had celiac axis stenosis, the stenosis rate ranged from 68% to 92%, with an average of 81%, and one patient had complete celiac axis occlusion. All the 6 patients underwent embolization coil occlusion of the PDAA and, in all of them, no treatment was performed for the celiac axis stenosis. The operative time ranged from 60 to 110 min, with an average of (76.7±13.5) min. After aneurysm embolization, the bleeding stopped in the 4 patients with ruptured aneurysm, and the aneurysm spontaneously disappeared in the two patients with unruptured aneurysm. The length of postoperative hospital stay ranged from 7 to 13 d, with an average of (10±2.3) d. Followed-up was conducted for 9 to 15 months, and no aneurysm recurrence or visceral ischemia occurred.
Conclusion: Embolization alone is safe and effective treatment for PDAA with celiac axis stenosis. Leaving the celiac axis stenosis untreated will not result in visceral ischemia, and increase the risk of aneurysm recurrence.