Aneurysm of pancreaticoduodenal arcade caused by medial arcuate ligament syndrome – case report and review of literature
Authors:
A. Hudák 1; I. Guňka 1; J. Raupach 2; M. Leško 1; A. Krajina 2; M. Lojík 2
Authors‘ workplace:
Chirurgická klinika Lékařské fakulty Univerzity Karlovy a Fakultní nemocnice Hradec Králové
1; Radiologická klinika Lékařské fakulty Univerzity Karlovy a Fakultní nemocnice Hradec Králové
2
Published in:
Rozhl. Chir., 2021, roč. 100, č. 6, s. 302-306.
Category:
Case Report
doi:
https://doi.org/10.33699/PIS.2021.100.6.302–306
Overview
Introduction: Visceral artery aneurysms are rare vascular pathologies. They are usually incidental findings during the examination for other reasons. The most common clinical symptoms are nonspecific abdominal pain and bleeding caused by their rupture, with a severe clinical presentation. Aneurysms of pancreaticoduodenal arcade are more common in patients with well-developed collateral circulation due to the coeliac trunk stenosis or occlusion.
Case report: In this case report the authors present a rare case of a patient with incidental finding of pancreaticoduodenal arcade aneurysm in the setting of severe stenosis of coeliac trunk origin caused by medial arcuate ligament compression. The diameter of the aneurysm was 40 mm and endovascular treatment was not possible because of unfavorable anatomical setting. The patient was successfully treated with resection of the aneurysm and the division of medial arcuate ligament during one surgery.
Conclusion: There is no correlation between the diameter and the risk of rupture of the pancreaticoduodenal arcade aneurysm. Because of high morbidity and mortality of their rupture, most authors recommend active treatment of these aneurysms. The necessity to treat truncus coeliacus stenosis or occlusion remains a controversial issue.
Keywords:
aneurysm − pancreaticoduodenal arcade − MALS
Sources
1. Johnston KW, Rutherford RB, Tilson MD, et al. Suggested standards for reporting on arterial aneurysms. Subcommittee on Reporting Standards for Arterial Aneurysms, Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery. J Vasc Surg. 1991;13(3):452−458. doi: S0741521491000794.
2. Stanley JC, Wakefield TW, Graham LM, et al. Clinical importance and management of splanchnic artery aneurysms. J Vasc Surg. 1986;3(5):836−840. doi: 0741- 5214(86)90059-5.
3. Ferguson F. Aneurysm of superior pancreaticoduodenal artery. Proc N Y Pathol Soc. 1895;24(45):9.
4. Sugiyama K, Takehara Y. Analysis of five cases of splanchnic artery aneurysm associated with coeliac artery stenosis due to compression by the median arcuate ligament. Clin Radiol. 2007;62(7):688−693. doi: 10.1016/j.crad.2007.02.002.
5. Kadir S, Athanasoulis CA, Yune HY, et al. Aneurysms of the pancreaticoduodenal arteries in association with celiac axis occlusion. Cardiovasc Radiol. 1978;1(3):173−177. doi: 10.1007/ bf02552029.
6. Sutton D, Lawton G. Coeliac stenosis or occlusion with aneurysm of the collateral supply. Clin Radiol. 1973;24(1):49−53. doi: 10.1016/s0009-9260(73)80114-x.
7. Ogino H, Sato Y, Banno T, et al. Embolization in a patient with ruptured anterior inferior pancreaticoduodenal arterial aneurysm with median arcuate ligament syndrome. Cardiovasc Intervent Radiol. 2002;25(4):318−319. doi: 10.1007/ s00270-001-0109-4.
8. Suzuki K, Kashimura H, Sato M, et al. Pancreaticoduodenal artery aneurysms associated with celiac axis stenosis due to compression by median arcuate ligament and celiac plexus. J Gastroenterol. 1998;33(3):434−438. doi: 10.1007/ s005350050109.
9. Kalva SP, Athanasoulis CA, Greenfield AJ, et al. Inferior pancreaticoduodenal artery aneurysms in association with celiac axis stenosis or occlusion. Eur J Vasc Endovasc Surg. 2007;33(6):670−675. doi: 10.1016/j. ejvs.2006.12.021.
10. Ducasse E, Roy F, Chevalier J, et al. Aneurysm of the pancreaticoduodenal arteries with a celiac trunk lesion: current management. J Vasc Surg. 2004;39(4):906−911. doi: 10.1016/j. jvs.2003.09.049.
11. de Perrot M, Berney T, Deleaval J, et al. Management of true aneurysms of the pancreaticoduodenal arteries. Ann Surg. 1999;229(3):416−420. doi: 10.1097/00000658-199903000-00016.
12. Moore E, Matthews MR, Minion DJ, et al. Surgical management of peripancreatic arterial aneurysms. J Vasc Surg. 2004;40(2):247−253. doi: 10.1016/j. jvs.2004.03.045.
13. Bjorck M, Koelemay M, Acosta S, et al. Editor‘ s choice − management of the diseases of mesenteric arteries and veins: Clinical Practice Guidelines of the European Society of Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2017;53(4):460−510. doi: 10.1016/j.ejvs.2017.01.010.
14. Mano Y, Takehara Y, Sakaguchi T, et al. Hemodynamic assessment of celiaco-mesenteric anastomosis in patients with pancreaticoduodenal artery aneurysm concomitant with celiac artery occlusion using flow-sensitive four-dimensional magnetic resonance imaging. Eur J Vasc Endovasc Surg. 2013;46(3):321−328. doi: 10.1016/j.ejvs.2013.06.011.
15. Heo S, Kim HJ, Kim B, et al. Clinical impact of collateral circulation in patients with median arcuate ligament syndrome. Diagn Interv Radiol. 2018 Jul;24(4):181−186. doi: 10.5152/dir.2018.17514.
16. Sgroi MD, Kabutey NK, Krishnam M, et al. Pancreaticoduodenal artery aneurysms secondary to median arcuate ligament syndrome may not need celiac artery revascularization or ligament release. Ann Vasc Surg. 2015;29(1):122 e1−7. doi: 10.1016/j.avsg.2014.05.020.
17. Reuter SR, Bernstein EF. The anatomic basis for respiratory variation in median arcuate ligament compression of the celiac artery. Surgery 1973;73(3):381−385. doi:0039-6060(73)90305-X.
18. Jimenez JC, Harlander-Locke M, Dutson EP. Open and laparoscopic treatment of median arcuate ligament syndrome. J Vasc Surg. 2012;56(3):869−873. doi: 10.1016/j.jvs.2012.04.057.
19. Chiou AC, Josephs LG, Menzoian JO. Inferior pancreaticoduodenal artery aneurysm: report of a case and review of the literature. J Vasc Surg. 1993;17(4):784−789. doi: 10.1067/mva.1993.40412.
20. Katsura M, Gushimiyagi M, Takara H, et al. True aneurysm of the pancreaticoduodenal arteries: a single institution experience. J Gastrointest Surg. 2010;14(9):1409−1413. doi: 10.1007/ s11605-010-1257-0.
21. Gangahar DM, Carveth SW, Reese HE, et al. True aneurysm of the pancreaticoduodenal artery: a case report and review of the literature. J Vasc Surg. 1985;2(5):741−742. doi: 0741-5214(85)90049-7.
22. Brocker JA, Maher JL, Smith RW. True pancreaticoduodenal aneurysms with celiac stenosis or occlusion. Am J Surg. 2012;204(5):762−768. doi: 10.1016/j.amjsurg. 2012.03.001.
23. Obara H, Kentaro M, Inoue M, et al. Current management strategies for visceral artery aneurysms: an overview. Surg Today 2020;50(1):38−49. doi: 10.1007/ s00595-019-01898-3.
24. Cordova AC, Sumpio BE. Visceral artery aneurysms and pseudoaneurysms - should they all be managed by endovascular techniques? Ann Vasc Dis. 2013;6(4):687−693. doi: 10.3400/avd. ra.13-00045.
25. Skipworth JR, Morkane C, Raptis DA, et al. Coil migration − a rare complication of endovascular exclusion of visceral artery pseudoaneurysms and aneurysms. Ann R Coll Surg Engl. 2011;93(4):e19−23. doi: 10.1308/003588411X13008844298652.
26. van Ouwerkerk L. Aneurysm of the arteria pancreatico-duodenalis. Arch Chir Neerl. 1951;3(1):11−7.
27. Boll JM, Sharp KW, Garrard CL, et al. Does management of true aneurysms of peripancreatic arteries require repair of associated celiac artery stenosis? J Am Coll Surg. 2017;224(2):199−203. doi: 10.1016/j.jamcollsurg.2016.10.030.
28. Yamana F, Ohata T, Kitahara M, et al. Blood flow modification might prevent secondary rupture of multiple pancreaticoduodenal artery arcade aneurysms associated with celiac axis stenosis. J Vasc Surg Cases Innov Tech. 2020;6(1):41−45. doi: 10.1016/j.jvscit.2019.10.005.
29. Flood K, Nicholson AA. Inferior pancreaticoduodenal artery aneurysms associated with occlusive lesions of the celiac axis: diagnosis, treatment options, outcomes, and review of the literature. Cardiovasc Intervent Radiol. 2013;36(3):578−587. doi: 10.1007/s00270-012-0473-2.
30. Nagano N, Takeuchi Y, Gomi A, et al. A case report of multiple aneurysms of pancreaticoduodenal region with celiac obstruction. [In Japanese] Nihon Geka Gakkai Zasshi. 1997;98(11):968−971.
31. Hasegawa T, Seiji K, Ota H, et al. Rapid development of new aneurysms in the adjacent pancreatic arcade arteries after urgent embolization of pancreaticoduodenal artery aneurysms in cases with celiac stenosis. J Vasc Interv Radiol. 2018;29(9):1306−8 e2. doi: 10.1016/j. jvir.2018.04.003.
32. Tien YW, Kao HL, Wang HP. Celiac artery stenting: a new strategy for patients with pancreaticoduodenal artery aneurysm associated with stenosis of the celiac artery. J Gastroenterol. 2004;39(1):81−85. doi: 10.1007/s00535-003-1251-3.
33. Fernstrum C, Pryor M, Wright GP, et al. Robotic surgery for median arcuate ligament syndrome. JSLS 2020;24(2). doi: 10.4293/JSLS.2020.00014.
Labels
Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2021 Issue 6
Most read in this issue
- Iodine seed localisation of non-palpable lesions in breast surgery − first experience
- Appendiceal mucocele – a radiologist’s view
- Phyllodes tumor and its malignization into invasive ductal carcinoma − a case report
- Role of the radiologist during neoadjuvant systemic therapy for breast cancer