Hughes Tom, Chatzizacharias Nikolaos A, Richards James, Harper Simon
Department of Hepatobilliary and Pancreatic Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 2QQ, UK.
Int J Surg Case Rep. 2016;28:131-134. doi: 10.1016/j.ijscr.2016.09.035. Epub 2016 Sep 26.
Inferior pancreatico-duodenal artery (IPDA) aneurysms are very rare and commonly associated with coeliac axis stenosis or occlusion due to atherosclerosis, thrombosis or median arcuate ligament syndrome. We present a case of a surgical repair of an IPDA aneurysm with the use of a supra-coeliac aorto-hepatic bypass with a polytetrafluoroethylene (PTFE) graft, following a failed initial attempt at an endovascular repair.
A 75 year old female, who was under investigation for night sweats, was referred to our team with an incidental finding of a 19mm fusiform IPDA aneurysm. Initial attempt at endovascular coiling of the aneurysm was unsuccessful. Elective surgical repair involved excision of the aneurysm and to restore arterial inflow to the hepatic artery, a PTFE bypass graft was used from the supra-coeliac aorta to the hepatic artery. The patient was well 2 months following the procedure with a patent graft shown on contrast enhanced computer tomography (ceCT).
Management options for IPDA aneurysms include radiologically guided endovascular approach or surgical repair. Given the high mortality of greater than 50% with ruptured aneurysms intervention is indicated in all detected cases.
Surgical excision with bypass grafting from the supra-coeliac aorta, as reported by our team, represents a satisfactory management option in patients where interventional approaches have failed or are not appropriate.
胰十二指肠下动脉（IPDA）动脉瘤非常罕见，通常与因动脉粥样硬化、血栓形成或正中弓状韧带综合征导致的腹腔干狭窄或闭塞相关。我们报告一例IPDA动脉瘤的手术修复病例，该患者在首次血管内修复尝试失败后，使用聚四氟乙烯（PTFE）移植物进行了腹腔干上方主动脉-肝旁路手术。
一名75岁女性因盗汗接受检查，偶然发现一个19mm的梭形IPDA动脉瘤，遂转诊至我们团队。对该动脉瘤进行血管内栓塞的首次尝试未成功。择期手术修复包括切除动脉瘤，并为恢复肝动脉的血流，使用PTFE旁路移植物从腹腔干上方主动脉连接至肝动脉。术后2个月患者情况良好，增强计算机断层扫描（ceCT）显示移植物通畅。
IPDA动脉瘤的治疗选择包括放射学引导下的血管内治疗或手术修复。鉴于动脉瘤破裂的死亡率高于50%，所有检测到的病例均需进行干预。
如我们团队所报告的，采用腹腔干上方主动脉旁路移植术进行手术切除，对于介入治疗失败或不适用的患者而言，是一种令人满意的治疗选择。
