AB039. SOH22ABS137. Staged treatment for pancreaticoduodenal artery aneurysm with celiac artery revascularisation: case report and systematic review
Vascular Session

AB039. SOH22ABS137. Staged treatment for pancreaticoduodenal artery aneurysm with celiac artery revascularisation: case report and systematic review

Liga Akmenkalne, Baker Ghoneim, Conor Nash, Sinead Cremen, Adeel Zafar Syed, Kenneth Thornton, Mohamed Elkassaby, Sean O’Neill, Catriona Canning, Mary Paula Colagan, Zenia Martin, Prakash Madhavan, Adrian O’Callaghan

Department of Vascular Surgery, St. James’s Hospital, Ireland

Background: Despite being rare, peripancreatic arteries aneurysms (PPAAs) carry a risk of rupture of up to 50%. PPAAs are frequently associated with Coeliac artery (CA) occlusion.

Methods: PubMed and Embase databases were searched using appropriate terms. The systematic review was conducted according to PRISMA guidelines.

Results: We present a case of a PPAA associated with CA occlusion, with a systematic review of PPAAs. Pre-operative angiography demonstrated that the pancreaticoduodenal artery was providing collateral blood supply to the liver. Treatment was staged hybrid intervention whit aorto-hepatic bypass using 6 mm graft followed by coil embolization of the aneurysm. Two hundred and ninety-two publications were identified, with 81 publications included in the final review. One hundred and seventy-five of the cases (61%) were associated with CA disease either occlusion or stenosis. Abdominal pain was the main presentation in 158 cases. Rupture occurred in 111 (40%) of patients, while 10 cases were unstable on presentation. Fifty (18%) cases were detected incidentally while investigating another pathology. One hundred and forty-one (54.6%) cases were treated by coil embolization only, while 37 cases had open surgery. Twenty-one cases needed trans-arterial embolisation (TAE) and celiac stent. Seventeen cases underwent hybrid treatment, while 16 cases had conservative treatment. In 26 cases treatment was not specified.

Conclusions: The scarcity in literature about true PPAAs associated with CA occlusive disease makes it difficult to assess the natural history or the appropriate treatment. However, embolization alone seems to be associated with higher ischemic foregut complications and Staged hybrid treatment with revascularization then TAE seems to be the safest treatment.

Keywords: Coeliac artery (CA); endovascular repair; hybrid repair; pancreaticoduodenal artery aneurysm; systematic review

Acknowledgments

Funding: None.

Footnote

Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/map-22-ab039
Cite this abstract as: Akmenkalne L, Ghoneim B, Nash C, Cremen S, Syed AZ, Thornton K, Elkassaby M, O’Neill S, Canning C, Colagan MP, Martin Z, Madhavan P, O’Callaghan A. AB039. SOH22ABS137. Staged treatment for pancreaticoduodenal artery aneurysm with celiac artery revascularisation: case report and systematic review. Mesentery Peritoneum 2022;6:AB039.

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