title: Pancreaticoduodenal and Gastroduodenal Artery Aneurysms Associated with Celiac Artery Occlusive Disease.
abstract: BACKGROUND
  The purpose of this study is to better define the clinical relevance of aneurysms affecting collateral vessels in patients with celiac artery (CA) occlusive disease.
  
  
  METHODS
  True pancreaticoduodenal artery (PDA) and gastroduodenal artery (GDA) aneurysms associated with CA stenoses or occlusions reported from 1970 to 2010 in the English literature and similar cases treated at the University of Michigan were reviewed. Clinical presentations and differing treatment modalities were documented and analyzed.
  
  
  RESULTS
  One hundred twenty-five patients having CA occlusive disease exhibited true arterial aneurysms affecting the PDA (105 patients), GDA (10 patients), or both PDA and GDA and their branches (10 patients). Aneurysm size averaged 2.1 cm. Included were 110 patients culled from the literature and 15 treated by the authors. The mean age of patients in this series was 59 years and there was no gender predilection. Aneurysms were asymptomatic in 26%. Abdominal pain affected 54% of the patients, including all who experienced rupture. Rupture occurred in 48 patients of whom 15 were hemodynamically unstable, including 6 who died. Surgical interventions included endovascular embolization (39), aneurysmectomy alone (25), and aneurysmectomy with arterial reconstruction (20). Salutary outcomes occurred in 91% of the cases. Open surgical procedures have remained constant, but were equaled by endovascular interventions in 1996, with the latter having increased 3-fold in the past 15 years.
  
  
  CONCLUSIONS
  PDA and GDA aneurysms associated with CA occlusive disease carry a high risk of nonfatal rupture, warranting early treatment. Endovascular and open interventions may be successfully undertaken with minimal risks in treating these uncommon aneurysms.
authors.affiliation: Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Frank C
authors.initials: FC
authors.lastname: Vandy
authors.affiliation: Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Kristen A
authors.initials: KA
authors.lastname: Sell
authors.affiliation: Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Eliason
authors.affiliation: Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Coleman
authors.affiliation: Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: John E
authors.initials: JE
authors.lastname: Rectenwald
authors.affiliation: Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI. Electronic address: jstanley@umich.edu.
authors.forename: James C
authors.initials: JC
authors.lastname: Stanley
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D001157:Arterial Occlusive Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D001158:Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D002445:Celiac Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D003097:Collateral Circulation; D000072226:Computed Tomography Angiography; D003251:Constriction, Pathologic; D004386:Duodenum / Q000098:blood supply*; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D008297:Male; D008824:Michigan; D008875:Middle Aged; D010179:Pancreas / Q000098:blood supply*; D012307:Risk Factors; D013152:Splanchnic Circulation; D013270:Stomach / Q000098:blood supply*; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures