Ikeda Osamu, Nakasone Yutaka, Yokoyama Koichi, Inoue Seijiro, Tamura Yoshitaka, Yamashita Yasuyuki
Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, Honjo Kumamoto, Japan.
Acta Radiol. 2013 Oct;54(8):949-53. doi: 10.1177/0284185113488577. Epub 2013 May 16.
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.
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.
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.
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.
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.
胰十二指肠动脉弓动脉瘤导致的胰十二指肠动脉弓血管退变与腹腔干狭窄或闭塞相关。尽管技术进步已使通过血管内技术治疗胰十二指肠动脉弓动脉瘤（PDAA）和腹腔干狭窄成为可能，但对于其最佳治疗方法尚无共识。
通过同时进行弹簧圈栓塞和腹腔干支架置入术治疗胰十二指肠动脉弓动脉瘤（PDAA），并提出用该方法治疗合并腹腔干狭窄的PDAA的适应证。
我们回顾了11例行经导管弹簧圈栓塞术（TCE）治疗PDAA的患者。当瘤颈大小小于动脉瘤短轴的一半时，我们仅采用填塞法；当瘤颈大小大于短轴的一半时，我们进行孤立术。在后一种情况下，若有腹腔干狭窄的证据，我们使用自膨式支架进行腹腔干支架置入术。
11例患者中有10例（91%）因正中弓状韧带压迫出现腹腔干狭窄。仅对瘤囊进行弹簧圈填塞以保留原动脉循环的有5例患者，另外5例通过栓塞PDAA远近端血管并同时对狭窄的腹腔干进行支架置入术进行孤立术，1例患者仅接受了孤立术。1例患者发生急性胰腺炎。无其他并发症，所有动脉瘤均成功排除。1例患者在停用抗血小板治疗方案后腹腔干支架形成血栓。
TCE对PDAA患者可能有效。在存在腹腔干狭窄的情况下，我们建议使用自膨式支架对动脉瘤进行孤立术并同时对狭窄的腹腔干进行支架置入术。
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