True pancreaticoduodenal artery aneurysms: a decision analysis.
OBJECTIVE
True pancreaticoduodenal artery aneurysms are rare. No definitive study evaluating the natural history of these lesions or their preferred method of treatment has been published. The purpose of this study was to evaluate the outcome of preventive treatment of unruptured pancreaticoduodenal artery aneurysms using a Markov model.


METHODS
With the use of a Markov model, we performed a decision analysis to evaluate the outcome of preventive treatment of unruptured pancreaticoduodenal artery aneurysms. The risk of rupture and the mortality of preventive treatment are unknown. Therefore, we performed sensitivity analysis using these parameters. Effectiveness was measured in life expectancy.


RESULTS
For 80-year-old patients, preventive treatment was dominated by no treatment if mortality rates of preventive treatment were greater than 1.4%, greater than 2.6%, greater than 3.8%, and greater than 4.8% at annual rupture rates of 1%, 2%, 3%, and 4%, respectively. For 50-year-old patients, preventive treatment was dominated by no treatment if mortality rates of preventive treatment were greater than 3.3%, greater than 5.9%, greater than 8.0%, and greater than 9.7% at annual rupture rates of 1%, 2%, 3%, and 4%, respectively.


CONCLUSIONS
The effectiveness of preventive treatment of unruptured pancreaticoduodenal artery aneurysms depends on the aneurysm rupture rate, mortality rate of preventive treatment, and patient age. Taking into account the effects of these parameters is important in making treatment decisions.
Takao
Hidemasa
H
Department of Radiology, Showa General Hospital, 2-450 Tenjincho, Kodaira, Tokyo, Japan. takaoh-tky@umin.ac.jp
Nojo
Takeshi
T
Ohtomo
Kuni
K
D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000175:diagnosis* / Q000401:mortality*; D020000:Decision Support Systems, Clinical; D003661:Decision Support Techniques; D004386:Duodenum / Q000098:blood supply*; D005260:Female; D006801:Humans; D008017:Life Expectancy; D008297:Male; D010179:Pancreas / Q000098:blood supply*; D015995:Prevalence; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate