Sharma Supriya, Prasad Raghunanadan, Gupta Archna, Dwivedi Pranav, Mohindra Samir, Yadav Rajanikant R
Department of Surgical Gastroenterology Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow India.
Department of Radiology Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow India.
JGH Open. 2020 Jul 8;4(5):923-928. doi: 10.1002/jgh3.12365. eCollection 2020 Oct.
Pancreaticoduodenal arcade aneurysms (PDAAs) are uncommon lesions associated with a significant risk of rupture and mortality. This study describes the etiology, clinical presentation, and endovascular management strategies of PDAAs across a spectrum of indications.
The clinical records of patients with PDAAs referred for endovascular management from January 2018 till November 2019 were retrospectively reviewed. Data on presenting symptoms, associated etiologies, and outcomes after endovascular treatment were collected and studied.
We found 15 patients with false and 1 patient with true aneurysm of pancreatoduodenal arcade (PDA). The associated conditions were coeliac artery stenosis, severe necrotizing pancreatitis, and chronic pancreatitis or iatrogenic (postendoscopic papillotomy and percutaneous metallic biliary stenting). The main presenting feature was gastrointestinal bleed, while 2 patients had abdominal pain and 1 had gastric outlet obstruction. A multiphase computed tomography scan demonstrated the ruptured aneurysm in all patients. Site of origin of PDAA influenced the choice of transarterial endovascular strategy (coiling for aneurysms of main trunk of arteries and glue injection for those arising from small arterial branches). This was carried out in an emergency setting for 12 patients and as an elective procedure in 4 patients. Technical success was demonstrated in all patients and clinical success in 14. The two patients who had rebleed were salvaged by repeat endovascular procedure. Postembolization syndrome was seen in three patients.
With advancing technology, endovascular strategies continue to evolve. Careful attention to ensure hemodynamic resuscitation and stability, correction of pre-existing coagulopathy and attention to technique can lead to the possibility of endovascular approaches as a dependable option in the management of ruptured PDAAs.
胰十二指肠动脉弓动脉瘤（PDAAs）是罕见病变，破裂风险和死亡率颇高。本研究描述了不同适应证下PDAAs的病因、临床表现及血管内治疗策略。
回顾性分析2018年1月至2019年11月因血管内治疗而转诊的PDAAs患者的临床记录。收集并研究有关临床表现、相关病因及血管内治疗后结局的数据。
我们发现15例为假性胰十二指肠动脉弓（PDA）动脉瘤，1例为真性动脉瘤。相关情况包括腹腔干狭窄、严重坏死性胰腺炎、慢性胰腺炎或医源性因素（内镜下乳头切开术后及经皮金属胆道支架置入术后）。主要临床表现为消化道出血，2例患者有腹痛，1例有胃出口梗阻。多期计算机断层扫描显示所有患者均有动脉瘤破裂。PDAA的起源部位影响经动脉血管内治疗策略的选择（动脉主干动脉瘤采用弹簧圈栓塞，小动脉分支动脉瘤采用胶水注射）。12例患者在急诊情况下进行了治疗，4例为择期手术。所有患者均实现技术成功，14例临床成功。2例再出血患者通过重复血管内手术挽救。3例患者出现栓塞后综合征。
随着技术进步，血管内治疗策略不断发展。仔细注意确保血流动力学复苏和稳定、纠正既往存在的凝血功能障碍并关注技术，可使血管内治疗成为治疗破裂PDAAs的可靠选择。
