title: Endovascular management of ruptured pancreaticoduodenal artery aneurysms associated with celiac axis stenosis.
abstract: The purpose of this study was to assess the efficacy of transcatheter arterial embolization for ruptured pancreaticoduodenal artery (PDA) aneurysms associated with celiac axis stenosis (CS). Seven patients (four men and three women; mean age, 64; range, 43-84) were treated with transcatheter arterial embolization between 2002 and 2007. They were analyzed with regard to the clinical presentation, radiological finding, procedure, and outcome. All patients presented with sudden epigastric pain or abdominal discomfort. Contrast-enhanced CT showed a small aneurysm and retroperitoneal hematoma around the pancreatic head in all patients. The aneurysms ranged from 0.3 to 0.9 cm in size. In one patient, two aneurysms were detected. The aneurysms were located in the pancreaticoduodenal artery (n = 5) and the dorsal pancreatic artery (n = 3). Embolization was performed with microcoils in all aneurysms (n = 8). N-Butyl 2-cyanoacrylate (n = 1) and gelatine particle (n = 1) were also used. Complete occlusion was achieved in four patients. In the other three patients, a significantly reduced flow to the aneurysm remained at final angiography. However, these aneurysms were thrombosed on follow-up CT within 2 weeks. And there was no recurrence of the symptoms and bleeding during follow-up (mean, 28 months; range, 5-65 months) in all patients. In conclusion, transcatheter arterial embolization for PDA aneurysms associated with CS is effective. Significant reduction of the flow to the aneurysm at final angiography may be predictive of future thrombosis.
authors.affiliation: Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya 466-8550, Japan. Kojiro@med.nagoya-u.ac.jp
authors.forename: Kojiro
authors.initials: K
authors.lastname: Suzuki
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Tachi
authors.forename: Shinji
authors.initials: S
authors.lastname: Ito
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Maruyama
authors.forename: Yoshine
authors.initials: Y
authors.lastname: Mori
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Komada
authors.forename: Masaya
authors.initials: M
authors.lastname: Matsushima
authors.forename: Toyohiro
authors.initials: T
authors.lastname: Ota
authors.forename: Shinji
authors.initials: S
authors.lastname: Naganawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000628:therapy*; D000792:Angiography; D002445:Celiac Artery; D003287:Contrast Media; D004386:Duodenum / Q000098:blood supply*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000098:blood supply*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media