title: Simultaneous coil embolization and angioplasty using a self-expanding nitinol stent to treat pancreaticoduodenal artery aneurysms associated with celiac artery stenosis.
abstract: BACKGROUND
  The degeneration of pancreaticoduodenal arcade vessels due to pancreaticoduodenal artery aneurysms is associated with celiac artery stenosis or occlusion. While technical advances have made it possible to treat pancreaticoduodenal arcade aneurysms (PDAA) and celiac artery stenosis by endovascular techniques, there is no consensus regarding their optimal treatment.
  
  
  OBJECTIVE
  To treat pancreaticoduodenal arcade aneurysms (PDAA) by simultaneous coil embolization and celiac artery stenting, and propose indications for treating PDAA with celiac artery stenosis by this method.
  
  
  METHODS
  We reviewed 11 patients who underwent transcatheter coil embolization (TCE) to treat PDAA. When the aneurysmal neck size was less than half of the short axis of the aneurysm we used packing only, when it was more than half of the short axis we undertook isolation. In the latter situation, when there was evidence of celiac artery stenosis, we performed celiac artery stenting using self-expandable stents.
  
  
  RESULTS
  Ten of the 11 patients (91%) presented with celiac axis stenosis due to median arcuate ligament compression. Coil-packing of the aneurysmal sac only, thus preserving the native arterial circulation, was done in five patients, another five underwent isolation by embolization of vessels distal and proximal to the PDAA with simultaneous stenting of the stenotic celiac axis, and one patient was treated by isolation only. One patient developed acute pancreatitis. There were no other complications and all aneurysms were successfully excluded. In one patient the celiac stent thrombosed after stopping the antiplatelet regimen.
  
  
  CONCLUSIONS
  TCE can be effective in patients with PDAA. In the presence of celiac artery stenosis, we recommend isolation of the aneurysms with simultaneous stenting of the stenotic celiac trunk using self-expandable stents.
authors.affiliation: Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, Honjo Kumamoto, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Ikeda
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Nakasone
authors.forename: Koichi
authors.initials: K
authors.lastname: Yokoyama
authors.forename: Seijiro
authors.initials: S
authors.lastname: Inoue
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Tamura
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Yamashita
mesh_terms: D000368:Aged; D000497:Alloys / Q000627:therapeutic use*; D000783:Aneurysm / Q000209:etiology / Q000628:therapy*; D017130:Angioplasty / Q000379:methods*; D002445:Celiac Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D003251:Constriction, Pathologic / Q000150:complications / Q000628:therapy; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D007479:Iopamidol; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery; D011856:Radiographic Image Enhancement / Q000379:methods; D015607:Stents; D016896:Treatment Outcome
chemical_list: D000497:Alloys; C013616:nitinol; D007479:Iopamidol
keywords: Coil embolization; angioplasty; celiac artery stenosis; pancreaticoduodenal artery aneurysms; self-expanding nitinol stent