Pancreaticoduodenal and Gastroduodenal Artery Aneurysms Associated with Celiac Artery Occlusive Disease

• Published in: Annals of vascular surgery Vol. 41; pp. 32 - 40
• Main Authors: Vandy, Frank C, Sell, Kristen A, Eliason, Jonathan L, Coleman, Dawn M, Rectenwald, John E, Stanley, James C
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.05.2017
• Subjects: Abdominal Pain - etiology; Adult; Aged; Aged, 80 and over; Aneurysm - diagnostic imaging; Aneurysm - etiology; Aneurysm - physiopathology; Aneurysm - therapy; Aneurysm, Ruptured - diagnostic imaging; Aneurysm, Ruptured - etiology; Aneurysm, Ruptured - physiopathology; Aneurysm, Ruptured - therapy; Arterial Occlusive Diseases - complications; Arterial Occlusive Diseases - diagnostic imaging; Arterial Occlusive Diseases - physiopathology; Arterial Occlusive Diseases - therapy; Arteries - diagnostic imaging; Arteries - physiopathology; Arteries - surgery; Celiac Artery - diagnostic imaging; Celiac Artery - physiopathology; Celiac Artery - surgery; Collateral Circulation; Computed Tomography Angiography; Constriction, Pathologic; Duodenum - blood supply; Endovascular Procedures; Female; Humans; Male; Michigan; Middle Aged; Pancreas - blood supply; Risk Factors; Splanchnic Circulation; Stomach - blood supply; Surgery; Time Factors; Treatment Outcome; Vascular Surgical Procedures
• ISSN: 0890-5096; 1615-5947
• DOI: 10.1016/j.avsg.2016.09.018

Background The purpose of this study is to better define the clinical relevance of aneurysms affecting collateral vessels in patients with celiac artery (CA) occlusive disease. Methods True pancreaticoduodenal artery (PDA) and gastroduodenal artery (GDA) aneurysms associated with CA stenoses or occlusions reported from 1970 to 2010 in the English literature and similar cases treated at the University of Michigan were reviewed. Clinical presentations and differing treatment modalities were documented and analyzed. Results One hundred twenty-five patients having CA occlusive disease exhibited true arterial aneurysms affecting the PDA (105 patients), GDA (10 patients), or both PDA and GDA and their branches (10 patients). Aneurysm size averaged 2.1 cm. Included were 110 patients culled from the literature and 15 treated by the authors. The mean age of patients in this series was 59 years and there was no gender predilection. Aneurysms were asymptomatic in 26%. Abdominal pain affected 54% of the patients, including all who experienced rupture. Rupture occurred in 48 patients of whom 15 were hemodynamically unstable, including 6 who died. Surgical interventions included endovascular embolization (39), aneurysmectomy alone (25), and aneurysmectomy with arterial reconstruction (20). Salutary outcomes occurred in 91% of the cases. Open surgical procedures have remained constant, but were equaled by endovascular interventions in 1996, with the latter having increased 3-fold in the past 15 years. Conclusions PDA and GDA aneurysms associated with CA occlusive disease carry a high risk of nonfatal rupture, warranting early treatment. Endovascular and open interventions may be successfully undertaken with minimal risks in treating these uncommon aneurysms.