Endo Yoshiki, Sekino Hirofumi, Ishii Shiro, Okada Ryo, Kofunato Yasuhide, Nakano Hiroshi, Watanabe Yohei, Marubashi Shigeru, Kono Koji, Ito Hiroshi
Department of Radiology and Nuclear Medicine, Fukushima Medical University, 1 Hikariga-oka, Fukushima 960-1295, Japan.
Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, 1 Hikariga-oka, Fukushima 960-1295, Japan.
Radiol Case Rep. 2022 Aug 1;17(10):3663-3668. doi: 10.1016/j.radcr.2022.07.048. eCollection 2022 Oct.
Median arcuate ligament syndrome is a clinical condition in which the median arcuate ligament causes compression and narrowing of the celiac artery. It has been reported that collateral pathways, which is developed by the decrease of blood flow from the celiac artery, facilitates the formation of aneurysms. Aneurysms around the pancreas in particular require aggressive therapeutic intervention, because a rupture can be fatal. We herein report two cases of pancreaticoduodenal aneurysms associated with median arcuate ligament syndrome treated by coil embolization and median arcuate ligament incision. Case 1 required a hybrid procedure in which median arcuate ligament incision and coil embolization were performed simultaneously. In Case 2, the median arcuate ligament incision was performed about 3 months after emergency endovascular hemostasis for hemorrhagic duodenal ulcer. In both cases, there were no major postoperative complications and no recurrence of aneurysm. Median arcuate ligament incision may be effective to prevent organ ischemia and aneurysm recurrence after coil embolization of intra-abdominal aneurysms associated with median arcuate ligament syndrome.
正中弓状韧带综合征是一种临床病症，其中正中弓状韧带导致腹腔干受压和狭窄。据报道，由腹腔干血流减少所形成的侧支循环通路会促进动脉瘤的形成。特别是胰腺周围的动脉瘤需要积极的治疗干预，因为破裂可能是致命的。我们在此报告两例与正中弓状韧带综合征相关的胰十二指肠动脉瘤，采用弹簧圈栓塞和正中弓状韧带切开术进行治疗。病例1需要进行一种联合手术，即同时进行正中弓状韧带切开术和弹簧圈栓塞术。病例2在因出血性十二指肠溃疡进行紧急血管内止血后约3个月进行了正中弓状韧带切开术。在这两个病例中，均未出现重大术后并发症，且动脉瘤无复发。正中弓状韧带切开术对于预防与正中弓状韧带综合征相关的腹内动脉瘤进行弹簧圈栓塞术后的器官缺血和动脉瘤复发可能是有效的。
