A Case of Multiple Pancreaticoduodenal Artery Aneurysms Associated with a Splenic Artery Aneurysm, and the Celiac Axis Occlusion due to Median Arcuate Ligament Syndrome
- VernacularTitle:正中弓状靭帯症候群による腹腔動脈閉塞に多発性膵十二指腸動脈瘤と脾動脈瘤を合併した1例
- Author:
Yu OSHIMA
1
;
Osanori SOGABE
1
Author Information
- Keywords: median arcuate ligament syndrome; celiac axis occlusion; multiple aneurysms of the pancreaticoduodenal artery; splenic artery aneurysm
- From:Japanese Journal of Cardiovascular Surgery 2024;53(4):236-241
- CountryJapan
- Language:Japanese
- Abstract: Multiple pancreaticoduodenal artery aneurysms are occasionally reported, but there are few reports of three or more multiple pancreaticoduodenal artery aneurysms. In this case, we experienced a rare case of five multiple pancreaticoduodenal artery aneurysms and one splenic artery aneurysm associated with celiac axis occlusion due to median arcuate ligament syndrome. The four aneurysms located in the posterior aspect of the pancreas were treated with coil embolization. Prior to this, a superior mesenteric artery to gastroduodenal artery bypass was performed using the saphenous vein graft to prevent organ ischemia caused by occlusion of the major collateral vessels. Measurements of gastroduodenal artery pressure and systemic blood pressure before and after arterial occlusion and after bypass, as well as their ratios, are useful indicators of organ perfusion. No postoperative complications occurred. One posterior superior pancreaticoduodenal artery aneurysm was excised and showed pathologic findings of fibromuscular dysplasia. Although the aneurysm was 3 mm in size, the aneurysm wall was thinning, indicating a risk of rupture regardless of aneurysm size. Due to the presence of multiple artifacts on the CT scan, superior mesenteric artery angiography was performed in the post-operative period, confirming the patency of the bypass and the absence of recurrence of the pancreaticoduodenal artery aneurysm. In addition, no new changes were observed in a splenic artery aneurysm, confirming the efficacy of this approach. One of the pancreaticoduodenal artery aneurysms was re-evaluated using chest CT, which showed progressive calcification of the aneurysm wall over the previous 27 months, with no aneurysm enlargement observed. The coexistence of pancreaticoduodenal artery aneurysm and splenic artery aneurysm is rare, with only eight reported cases. All cases were in female patients, and among the eight cases, six were instances of multiple pancreaticoduodenal artery aneurysms, while four cases represented the uncommon occurrence of three or more multiple pancreaticoduodenal artery aneurysms. Postoperatively, local complications such as pancreatic fistula were common. To clarify the characteristics of this condition, it is considered necessary to accumulate cases in the future.
