Pancreaticoduodenal artery aneurysms: changing patterns.

A true pancreaticoduodenal artery (PDA) aneurysm (ie, one not associated with pancreatitis) is the second least common splanchnic artery aneurysm; it is usually situated in or near an area that is hard to dissect, and it has a distinct propensity to rupture. We reviewed a total of 36 cases of PDA aneurysm, including three from our institution, and we analyzed them in two time periods with relation to age, sex, method of diagnosis, morbidity, and mortality. Cases reported before 1970 were compared with those reported during or after 1970. The male-female ratio was 4:1 before 1970 and 1:1 after 1970, yet the mean age has stayed significantly lower for female populations (P less than .02). The use of angiography has increased significantly recently (P = .004). The overall mortality has not improved significantly (P = .08); however, if the initial diagnosis was made by angiography, the survival was significantly better (P less than .025). Surgical intervention remains the standard treatment, but preoperative angiography significantly improves operative results. Anecdotal reports suggest that selected high-risk cases may be successfully managed by therapeutic angiography with embolization.