Inferior Pancreaticoduodenal Artery Aneurysms Associated with Occlusive Lesions of the Celiac Axis: Diagnosis, Treatment
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REVIEW/STATE OF THE ART
Inferior Pancreaticoduodenal Artery Aneurysms Associated with Occlusive Lesions of the Celiac Axis: Diagnosis, Treatment Options, Outcomes, and Review of the Literature Karen Flood • Anthony A. Nicholson
Received: 15 January 2012 / Accepted: 15 August 2012 Ó Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2012
Abstract Purpose To describe the presentation, treatment, and outcomes for 14 patients with aneurysms of the inferior pancreaticoduodenal arteries associated with occlusive lesions of the celiac axis, and to review the literature for similar cases. Methods Over a period of 12 years, 14 patients (10 women and 4 men) ranging in age from 26 to 50 (mean 46) years were demonstrated to have aneurysms of the inferior pancreaticoduodenal artery origin associated with stenosis or occlusion of the celiac axis. All patients were treated by a combination of surgery and interventional radiology. Results Outcome data collected between 3 months and 4 years (mean 2 years) demonstrated that all aneurysms remained excluded, and all 14 patients were well. The 49 case reports in the literature confirm the findings of this cohort. Conclusion In inferior pancreaticoduodenal artery aneurysm resulting from celiac occlusive disease, endovascular treatment is best achieved by stenting the celiac axis and/or embolizing the aneurysm when necessary.
[1]. They occur as a result of trauma, surgery, pancreatitis, infections of the gallbladder, systemic vasculitides, and celiac axis stenosis or occlusion; they may also occur iatrogenically [1–4]. Celiac axis stenosis or occlusion causes true aneurysm formation. In 1973, Sutton et al. first described IPDA aneurysms in association with celiac axis stenosis/occlusion [5]. Subsequently, Kadir et al. [6] reported four cases where they postulated that increased retrograde blood flow through the collateral circulation might play a role in aneurysm development. We collated data on 14 patients with IPDA aneurysms and coexistent stenosis or occlusion of the celiac axis that covers the past 12 years. Here we correlate the findings in these patients with those from case reports in the literature to give an overview on the causation, presentation, pathophysiology, and natural history of IPDA aneurysms, as well as the most effective imaging and treatment options for these patients.
Materials and Methods Keywords Arterial intervention Clinical practice Embolization Embolotherapy
Introduction Inferior pancreaticoduodenal artery (IPDA) aneurysms are rare, accounting for 2 % of splanchnic artery aneurysms K. Flood (&) A. A. Nicholson Department of Radiology, Leeds Teaching Hospitals, 1 Great George Street, Leeds LS1 3EX, United Kingdom e-mail: [email protected]
Our study reviewed all patients treated for IPDA artery aneurysms resulting from celiac axis stenosis described between 1997 and 2012. Data were obtained from a prospectively held database. Details of clinical presentation, aneurysm siz
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