Department of Vascular Surgery, St James Hospital, Dublin, Ireland.
Vascular. 2024 Feb;32(1):162-178. doi: 10.1177/17085381221124991. Epub 2022 Sep 7.
Despite being rare, pancreaticoduodenal artery aneurysms (PDAAs) carry a risk of rupture of up to 50% and are frequently associated with coeliac artery occlusion.
PubMed and Embase databases were searched using appropriate terms. The systematic review was conducted according to PRISMA guidelines.
We present the case of a 2 cm pancreaticoduodenal artery aneurysm pre-operative angiography demonstrated that the coeliac artery was occluded and the pancreaticoduodenal artery was providing collateral blood supply to the liver. Treatment was a staged hybrid intervention inclusive of an aorto-hepatic bypass using a 6 mm graft, followed by coil embolisation of the aneurysm. We also present a systematic review of the management of PDAAs. Two hundred and ninety-two publications were identified initially with 81 publications included in the final review. Of the 258 peripancreatic aneurysms included, 175 (61%) were associated with coeliac artery disease either occlusion or stenosis. Abdominal pain was the main presentation in 158 cases. Rupture occurred in 111 (40%) of patients with only ten (3.8%) cases being unstable on presentation. Fifty (18%) cases were detected incidentally while investigating another pathology. Over half the cases (=141/54.6%) were treated by trans arterial embolisation (TAE) alone, while 37 cases had open surgery only. Twenty-one cases needed TAE and a coeliac stent. Seventeen cases underwent hybrid treatment (open and endovascular). Sixteen cases were treated conservatively and in 26 cases, treatment was not specified.
PDAAs are commonly associated with coeliac artery disease. The most common presentation is pain followed by rupture. The scarcity of literature about true peripancreatic artery aneurysms associated with CA occlusive disease makes it difficult to assess the natural history or the appropriate treatment. Revascularisation of hepatic artery is better done with bypass in setting of median arcuate ligament compression and occluded celiac trunk.
尽管胰腺十二指肠动脉动脉瘤（PDAAs）很少见，但破裂风险高达 50%，并且常与腹腔动脉闭塞有关。
使用适当的术语在 PubMed 和 Embase 数据库中进行搜索。系统评价按照 PRISMA 指南进行。
我们报告了一例 2 厘米的胰腺十二指肠动脉动脉瘤病例。术前血管造影显示腹腔动脉闭塞，胰腺十二指肠动脉为肝脏提供侧支血供。治疗采用分期杂交干预，包括使用 6 毫米移植物进行肝主动脉旁路，然后对动脉瘤进行线圈栓塞。我们还对 PDAAs 的治疗进行了系统评价。最初确定了 292 篇出版物，最终有 81 篇出版物纳入了最终评价。在纳入的 258 例胰周动脉瘤中，175 例（61%）与腹腔动脉疾病相关，包括闭塞或狭窄。158 例主要表现为腹痛。111 例（40%）患者发生破裂，仅 10 例（3.8%）患者在就诊时不稳定。50 例（18%）病例为偶然发现，同时还在研究另一种病理。超过一半的病例（=141/54.6%）仅通过经动脉栓塞（TAE）治疗，而 37 例仅行开放手术。21 例需要 TAE 和腹腔支架。17 例采用杂交治疗（开放和血管内）。16 例保守治疗，26 例未具体说明治疗方法。
PDAAs 常与腹腔动脉疾病有关。最常见的表现是疼痛，其次是破裂。由于缺乏关于与 CA 闭塞性疾病相关的真正胰周动脉动脉瘤的文献，因此难以评估其自然病史或适当的治疗方法。在正中弓状韧带压迫和腹腔干闭塞的情况下，肝动脉的血运重建最好通过旁路进行。
