title: Does Management of True Aneurysms of Peripancreatic Arteries Require Repair of Associated Celiac Artery Stenosis?
abstract: BACKGROUND
  True aneurysms of the gastroduodenal (GDA) and pancreaticoduodenal (PDA) arteries have been attributed to increased collateral flow due to tandem celiac artery stenosis or occlusion. Although GDA and PDA aneurysm exclusion is recommended because of the high reported risk of rupture, it remains uncertain whether simultaneous celiac artery reconstruction is necessary to preserve end-organ flow.
  
  
  METHODS
  We conducted a retrospective analysis of consecutive patients admitted from 1996 to 2015 with true aneurysms of the GDA or PDA.
  
  
  RESULTS
  Twenty patients with true aneurysms of the PDA (n = 16) or GDA (n = 4) were identified. Mean age was 61.5 years (range 35 to 85 years) and 11 (55%) were women. Nine (45%) presented with rupture, 8 (40%) presented with pain, and 3 (15%) were asymptomatic. All 9 patients who presented with rupture had contained retroperitoneal hematomas, and none experienced rebleeding. Fifteen (75%) patients had an associated celiac artery >60% stenosis or occlusion, and 2 (10%) had both celiac and superior mesenteric artery stenoses. Thirteen (65%) patients underwent successful endovascular coiling, only 1 of which had a prophylactic celiac artery bypass. Three (15%) patients underwent open aneurysm exclusion and celiac bypass, and 4 (20%) others were observed. There were no aneurysm-related deaths in this series, and none of the patients who underwent coiling without celiac revascularization had hepatic ischemia or other mesenteric morbidity develop during a median follow-up of 6 months (maximum 200 months).
  
  
  CONCLUSIONS
  Gastroduodenal artery and PDA aneurysms present most commonly with pain or bleeding, and all should be considered for repair, regardless of size. Aneurysm exclusion is safely and effectively achieved with endovascular coiling. Although associated celiac artery stenosis is found in the majority of cases, celiac revascularization might not be necessary.
authors: Division of Vascular Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors: Julia M
authors: JM
authors: Boll
authors: Division of General Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors: Kenneth W
authors: KW
authors: Sharp
authors: Division of Vascular Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors: C Louis
authors: CL
authors: Garrard
authors: Division of Vascular Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors: Thomas C
authors: TC
authors: Naslund
authors: Division of Vascular Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors: John A
authors: JA
authors: Curci
authors: Division of Vascular Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN. Electronic address: james.valentine@vanderbilt.edu.
authors: R James
authors: RJ
authors: Valentine
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000150:complications / Q000628:therapy*; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000601:surgery*; D002445:Celiac Artery / Q000601:surgery*; D004386:Duodenum / Q000098:blood supply*; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000098:blood supply*; D012189:Retrospective Studies; D013270:Stomach / Q000098:blood supply*; D016896:Treatment Outcome