title: Aneurysms of Peripancreatic Arterial Arcades Coexisting with Celiac Trunk Stenosis or Occlusion: Single Institution Experience.
abstract: Introduction. True aneurysms of peripancreatic arterial arcades (PAAAs) are rare. Most of them coexist with celiac axis stenosis/occlusion due to median arcuate ligament (MAL) compression or atherosclerosis. The aim of this study was to evaluate the cause of celiac axis lesion and characterize the anatomy of the aneurysms. These findings may have important management implications.Material and Methods. A retrospective analysis of 15 patients with true PAAAs was performed. The diagnosis was established by contrast-enhanced CT, using a 64-MDCT scanner. We evaluated the most probable cause of celiac axis lesion. Aneurysms were characterized by their number, location, size, and morphology. Location of the aneurysms was classified either as pancreaticoduodenal arteries (PDA) or as dorsal pancreatic arteries (DPA) as they may represent different collateral pathways between superior mesenteric artery and celiac trunk.Results. A total of 32 true PAAAs were identified. Celiac trunk was occluded in 12 patients and critically narrowed in 3 patients. Celiac axis lesion was categorized as secondary to MAL compression in 14 cases and due to atherosclerosis in 1 case. The most common location of the aneurysms was inferior pancreaticoduodenal arteries. Only in 1 case aneurysms involved both PDA and DPA.Conclusions. Coexistence of PAAAs with celiac axis compression as well as involvement of either PDAs or DPAs has important therapeutic implications. The uninvolved collateral pathway may be sufficient to preserve effective circulation in celiac trunk branches in case of resection or embolization of the aneurysms. However, further studies are crucial to confirm our findings.
authors.affiliation: 2nd Department of Radiology, Medical University of Warsaw, Banacha 1a St., 02-097 Warsaw, Poland.
authors.forename: Robert
authors.initials: R
authors.lastname: Antoniak
authors.affiliation: 2nd Department of Radiology, Medical University of Warsaw, Banacha 1a St., 02-097 Warsaw, Poland.
authors.forename: Laretta
authors.identifier: 0000-0002-6511-6579
authors.initials: L
authors.lastname: Grabowska-Derlatka
authors.affiliation: Department of General, Vascular, and Transplantation Surgery, Medical University of Warsaw, Banacha 1a St., 02-097 Warsaw, Poland.
authors.forename: Ireneusz
authors.identifier: 0000-0002-4407-8614
authors.initials: I
authors.lastname: Nawrot
authors.affiliation: 2nd Department of Radiology, Medical University of Warsaw, Banacha 1a St., 02-097 Warsaw, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Cieszanowski
authors.affiliation: 2nd Department of Radiology, Medical University of Warsaw, Banacha 1a St., 02-097 Warsaw, Poland.
authors.forename: Olgierd
authors.initials: O
authors.lastname: Rowiński
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D002445:Celiac Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D000072226:Computed Tomography Angiography; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D012189:Retrospective Studies