Combined treatment of an aortosplenic bypass followed by coil embolization in the treatment of pancreaticoduodenal artery aneurysms caused by median arcuate ligament compression: a report of two cases

Surgical Case Reports

Tomonori Ooka¹  Satoru Wakasa¹  Daisuke Abo²  Takeshi Soyama²  Shuhei Kii³  Toshiya Kamiyama³  Takuya Kato³  Kenji Wakayama³  Yousuke Tsuruga³  Akinobu Taketomi³  Tatsuhiko Kakisaka³  Hirofumi Kamachi³ 

[1] Department of Cardiovascular and Thoracic Surgery, Hokkaido University Faculty and School of Medicine, N15, W7, Kita-ku, 060-8638, Sapporo, Japan;Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N15, W7, Kita-ku, 060-8638, Sapporo, Japan;Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, N15, W7, Kita-ku, 060-8638, Sapporo, Japan;

关键词: Bypass surgery;    Embolization;    Pancreaticoduodenal artery aneurysm;   

DOI  :  10.1186/s40792-021-01260-1

来源: Springer

【 摘 要 】

BackgroundPancreaticoduodenal artery aneurysms (PDAAs) are rare visceral aneurysms, and prompt intervention/treatment of all PDAAs is recommended at the time of diagnosis to avoid rupture of aneurysms. Herein, we report two cases of PDAA caused by the median arcuate ligament syndrome, treated with surgical revascularization by aortosplenic bypass followed by coil embolization.Case presentationCase 1 A 54-year-old woman presented with a chief complaint of severe epigastralgia and was diagnosed with two large fusiform inferior PDAAs and celiac axis occlusion. To preserve the blood flow of the pancreatic head, duodenum, liver, and spleen, we performed elective surgery to release the MAL along with aortosplenic bypass. At 6 days postoperatively, transcatheter arterial embolization was performed. At the 8-year 6-month follow-up observation, no recurrent perfusion of the embolized PDAAs or rupture had occurred, including the non-embolized small PDAA, and the bypass graft had excellent patency.Case 2 A 39-year-old man who had been in good health was found to have a PDAA with celiac stenosis during a medical checkup. Computed tomography and superior mesenteric arteriography showed severe celiac axis stenosis and a markedly dilated pancreatic arcade with a large saccular PDAA. To preserve the blood flow of the pancreatic arcade, we performed elective surgery to release the MAL along with aortosplenic bypass. At 9 days postoperatively, transcatheter arterial embolization was performed. At the 6-year 7-month follow-up observation, no recurrent perfusion or rupture of the PDAA had occurred, and the bypass graft had excellent patency.ConclusionCombined treatment with bypass surgery and coil embolization can be an effective option for the treatment of PDAAs associated with celiac axis occlusion or severe stenosis.

【 授权许可】

CC BY