Voigt Marilia B, Kupczyk Patrick A, Kania Alexander, Meyer Carsten, Wagenpfeil Julia, Dell Tatjana, Pieper Claus-Christian, Luetkens Julian A, Kuetting Daniel
Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany.
Department of Visceral and Vascular Surgery, University Hospital Bonn, Bonn, Germany.
CVIR Endovasc. 2025 Mar 19;8(1):23. doi: 10.1186/s42155-025-00533-2.
To identify the frequency and association of visceral arterial (VA) stenosis in peripancreatic aneurysms (PPAs) and to develop a uniform, more detailed treatment strategy for PPAs in case of accompanying VA stenosis, as current guidelines do not adequately address this constellation.
Patients with PPAs diagnosed at a tertiary care hospital were retrospectively analyzed. In case of multiple PPAs, the aneurysm with the highest aneurysm-to-vessel ratio (AVR) within the celiac-mesenteric collateral circulation was classified as the primary aneurysm and categorized as "critical" or "non-critical" based on the risk of organ ischemia. Celiac artery and superior mesenteric artery stenoses were graded as low (< 50%), high (> 50%), or total occlusion. Treatment strategies were based on VA stenosis severity, aneurysm classification, and morphology. Treatment strategies included endovascular, surgical and watch-and-wait management.
Thirty-one patients with PPAs were included with a total of 53 aneurysms; mean aneurysm size: 12.5 ± 7.9 mm (range 5-38 mm), AVR: 3.5 ± 2.1 (range 1-11.3). The superior and inferior pancreaticoduodenal arteries as well as the pancreaticoduodenal arcade were affected in most cases (67.9%). AVR was significantly higher in cases of aneurysm rupture (6.2 ± 2.8; p = 0.031). Celiac artery stenosis was present in 87.1%. Aneurysm size and occurrence of active bleeding did not correlate (p = 0.925). 11 patients presented with critical aneurysms, with 10 patients requiring individually tailored treatment. Non-critical aneurysms were treated with coil embolization in most cases.
CA stenosis, aneurysm position, and AVR significantly influence treatment decisions. Individualized approaches based on anatomical and hemodynamic factors are needed in PPA treatment.
确定胰周动脉瘤（PPA）中内脏动脉（VA）狭窄的频率及相关性，并针对伴有VA狭窄的PPA制定统一、更详细的治疗策略，因为当前指南未充分涉及这种情况。
对在一家三级医院诊断为PPA的患者进行回顾性分析。对于多发PPA，将腹腔干 - 肠系膜侧支循环内动脉瘤与血管比例（AVR）最高的动脉瘤分类为主要动脉瘤，并根据器官缺血风险分为“临界”或“非临界”。腹腔干动脉和肠系膜上动脉狭窄分为轻度（<50%）、重度（>50%）或完全闭塞。治疗策略基于VA狭窄严重程度、动脉瘤分类和形态。治疗策略包括血管内治疗、手术治疗和观察等待处理。
纳入31例PPA患者，共53个动脉瘤；平均动脉瘤大小：12.5±7.9毫米（范围5 - 38毫米），AVR：3.5±2.1（范围1 - 11.3）。大多数病例（67.9%）中胰十二指肠上、下动脉以及胰十二指肠动脉弓受累。动脉瘤破裂病例的AVR显著更高（6.2±2.8；p = 0.031）。87.1%存在腹腔干动脉狭窄。动脉瘤大小与活动性出血的发生无相关性（p = 0.925）。11例患者出现临界动脉瘤，其中10例患者需要个体化定制治疗。大多数非临界动脉瘤采用弹簧圈栓塞治疗。
腹腔干动脉狭窄、动脉瘤位置和AVR显著影响治疗决策。PPA治疗需要基于解剖和血流动力学因素的个体化方法。
