Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Ann R Coll Surg Engl. 2022 May;104(5):e143-e146. doi: 10.1308/rcsann.2021.0200. Epub 2022 Jan 4.
Giant celiac artery aneurysm is a rare entity. We describe a case of a 45-year-old male with chronic kidney disease who presented with abdominal pain for the past 6 months. CT showed a celiac artery aneurysm of size 6×6.2cm involving the common hepatic artery and compressing the portal vein posteriorly. During the procedure the supra celiac aorta was exposed, and the neck of the aneurysm was identified. After taking control of branches of the celiac and common hepatic arteries, the neck of the aneurysm was clamped and divided. In view of diminished flow in the hepatic arteries aorto hepatic bypass was done using PTFE graft from supra celiac aorta to right hepatic artery; as there was retrograde flow from the left hepatic artery it was ligated. Post operatively the patient's liver functions were normal, and he was followed up by Doppler sonography which detected good flow in the hepatic artery distal to anastomosis. Celiac artery aneurysms are rare, and management options vary from the endovascular to surgery; regardless of the approach used, revascularisation is needed if there is no adequate collateral flow.
巨大腹腔干动脉瘤较为罕见。我们描述了一例 45 岁男性慢性肾脏病患者,其因过去 6 个月腹痛就诊。CT 显示腹腔干动脉瘤大小为 6×6.2cm,累及肝总动脉并向后压迫门静脉。手术过程中显露腹腔干上动脉,并确定动脉瘤颈部位置。在控制腹腔干和肝总动脉分支后,夹闭并横断动脉瘤颈部。由于肝动脉血流减少,使用从腹腔干至上肝动脉的 PTFE 移植物进行肝总动脉-肝动脉旁路术;由于左肝动脉有逆行血流,因此对其进行结扎。术后患者肝功能正常,并通过多普勒超声检查,发现吻合口远端肝动脉血流良好。腹腔干动脉瘤较为罕见,治疗方法包括腔内治疗和手术治疗;无论采用何种方法,如果没有足够的侧支循环,都需要进行血运重建。