Document Detail


A ruptured pancreaticoduodenal artery aneurysm repaired by combined endovascular and open techniques.
MedLine Citation:
PMID:  17080233     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Aneurysms of the pancreaticoduodenal arteries (PDA) are rare, accounting for <2% of all visceral aneurysms. An association with celiac artery stenosis has been reported. Many present with rupture, and a high mortality can be expected. Treatment is therefore challenging. Arterial ligation, anuerysmectomy, or bypass has been the mainstay of treatment. We recently treated a patient (who had no celiac axis) with a ruptured PDA aneurysm with combined open and endovascular techniques. A 46-year-old man was transferred to our hospital with a 1-day history of abdominal pain and syncope. On admission, an abdominal and pelvis computerized tomographic (CT) scan identified a large mesenteric hematoma, a 1.9 cm PDA aneurysm, and an occluded celiac axis. Mesenteric angiography revealed no active aneurysm leak and a stenotic superior mesenteric artery (SMA) origin. All hepatic blood flow originated from the stenotic SMA via markedly enlarged PDA collaterals. The patient was brought to the operating room, where absence of the celiac axis was confirmed. An aorto-to-proper hepatic and SMA bypass was performed using a bifurcated polyester graft. The next day, the patient was brought to the angiography suite, where the PDA aneurysm was coiled. Postprocedure CT scans confirmed thrombosis of the aneurysm. Ruptured mesenteric artery aneurysms are a challenging problem for the vascular surgeon. PDA aneurysms are rare and often occur in an unfavorable location. There appears to be an association with anatomic anomalies of the mesenteric circulation. Prompt invasive and noninvasive diagnostic studies aid in the definitive management of this often fatal problem. Combined endovascular and open techniques can be used for successful treatment.
Authors:
Wang Teng; Mark R Sarfati; Michelle T Mueller; Larry W Kraiss
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Annals of vascular surgery     Volume:  20     ISSN:  0890-5096     ISO Abbreviation:  Ann Vasc Surg     Publication Date:  2006 Nov 
Date Detail:
Created Date:  2006-12-15     Completed Date:  2007-02-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8703941     Medline TA:  Ann Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  792-5     Citation Subset:  IM    
Affiliation:
Division of Vascular Surgery, University of Utah Health Sciences Center, Salt Lake City, UT, USA.
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MeSH Terms
Descriptor/Qualifier:
Aneurysm, Ruptured / physiopathology,  radiography,  surgery*
Angioplasty*
Aortography
Arteries / surgery
Celiac Artery / radiography
Collateral Circulation
Duodenum / blood supply*
Hepatic Artery / radiography
Humans
Male
Mesenteric Artery, Superior / radiography
Middle Aged
Pancreas / blood supply*
Radiography, Interventional
Splenic Artery / radiography
Tomography, X-Ray Computed
Treatment Outcome
Vascular Surgical Procedures / methods*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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