Combined treatment of an aortosplenic bypass followed by coil embolization in the treatment of pancreaticoduodenal artery aneurysms caused by median arcuate ligament compression: a report of two cases
Abstract Background Pancreaticoduodenal artery aneurysms (PDAAs) are rare visceral aneurysms, and prompt intervention/treatment of all PDAAs is recommended at the time of diagnosis to avoid rupture of aneurysms. Herein, we report two cases of PDAA caused by the median arcuate ligament syndrome, trea...
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Japan Surgical Society
2021-08-01
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| Series: | Surgical Case Reports |
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| Online Access: | https://doi.org/10.1186/s40792-021-01260-1 |
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| author | Shuhei Kii Hirofumi Kamachi Daisuke Abo Takuya Kato Yousuke Tsuruga Kenji Wakayama Tatsuhiko Kakisaka Takeshi Soyama Toshiya Kamiyama Tomonori Ooka Satoru Wakasa Akinobu Taketomi |
| author_facet | Shuhei Kii Hirofumi Kamachi Daisuke Abo Takuya Kato Yousuke Tsuruga Kenji Wakayama Tatsuhiko Kakisaka Takeshi Soyama Toshiya Kamiyama Tomonori Ooka Satoru Wakasa Akinobu Taketomi |
| author_sort | Shuhei Kii |
| collection | DOAJ |
| description | Abstract Background Pancreaticoduodenal artery aneurysms (PDAAs) are rare visceral aneurysms, and prompt intervention/treatment of all PDAAs is recommended at the time of diagnosis to avoid rupture of aneurysms. Herein, we report two cases of PDAA caused by the median arcuate ligament syndrome, treated with surgical revascularization by aortosplenic bypass followed by coil embolization. Case presentation Case 1 A 54-year-old woman presented with a chief complaint of severe epigastralgia and was diagnosed with two large fusiform inferior PDAAs and celiac axis occlusion. To preserve the blood flow of the pancreatic head, duodenum, liver, and spleen, we performed elective surgery to release the MAL along with aortosplenic bypass. At 6 days postoperatively, transcatheter arterial embolization was performed. At the 8-year 6-month follow-up observation, no recurrent perfusion of the embolized PDAAs or rupture had occurred, including the non-embolized small PDAA, and the bypass graft had excellent patency. Case 2 A 39-year-old man who had been in good health was found to have a PDAA with celiac stenosis during a medical checkup. Computed tomography and superior mesenteric arteriography showed severe celiac axis stenosis and a markedly dilated pancreatic arcade with a large saccular PDAA. To preserve the blood flow of the pancreatic arcade, we performed elective surgery to release the MAL along with aortosplenic bypass. At 9 days postoperatively, transcatheter arterial embolization was performed. At the 6-year 7-month follow-up observation, no recurrent perfusion or rupture of the PDAA had occurred, and the bypass graft had excellent patency. Conclusion Combined treatment with bypass surgery and coil embolization can be an effective option for the treatment of PDAAs associated with celiac axis occlusion or severe stenosis. |
| format | Article |
| id | doaj-art-ef2fd46ef8d44fe0960e6872ff9d76ae |
| institution | DOAJ |
| issn | 2198-7793 |
| language | English |
| publishDate | 2021-08-01 |
| publisher | Japan Surgical Society |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj-art-ef2fd46ef8d44fe0960e6872ff9d76ae2025-08-20T03:22:42ZengJapan Surgical SocietySurgical Case Reports2198-77932021-08-01711910.1186/s40792-021-01260-1Combined treatment of an aortosplenic bypass followed by coil embolization in the treatment of pancreaticoduodenal artery aneurysms caused by median arcuate ligament compression: a report of two casesShuhei Kii0Hirofumi Kamachi1Daisuke Abo2Takuya Kato3Yousuke Tsuruga4Kenji Wakayama5Tatsuhiko Kakisaka6Takeshi Soyama7Toshiya Kamiyama8Tomonori Ooka9Satoru Wakasa10Akinobu Taketomi11Department of Gastroenterological Surgery I, Hokkaido University Graduate School of MedicineDepartment of Gastroenterological Surgery I, Hokkaido University Graduate School of MedicineDepartment of Diagnostic and Interventional Radiology, Hokkaido University HospitalDepartment of Gastroenterological Surgery I, Hokkaido University Graduate School of MedicineDepartment of Gastroenterological Surgery I, Hokkaido University Graduate School of MedicineDepartment of Gastroenterological Surgery I, Hokkaido University Graduate School of MedicineDepartment of Gastroenterological Surgery I, Hokkaido University Graduate School of MedicineDepartment of Diagnostic and Interventional Radiology, Hokkaido University HospitalDepartment of Gastroenterological Surgery I, Hokkaido University Graduate School of MedicineDepartment of Cardiovascular and Thoracic Surgery, Hokkaido University Faculty and School of MedicineDepartment of Cardiovascular and Thoracic Surgery, Hokkaido University Faculty and School of MedicineDepartment of Gastroenterological Surgery I, Hokkaido University Graduate School of MedicineAbstract Background Pancreaticoduodenal artery aneurysms (PDAAs) are rare visceral aneurysms, and prompt intervention/treatment of all PDAAs is recommended at the time of diagnosis to avoid rupture of aneurysms. Herein, we report two cases of PDAA caused by the median arcuate ligament syndrome, treated with surgical revascularization by aortosplenic bypass followed by coil embolization. Case presentation Case 1 A 54-year-old woman presented with a chief complaint of severe epigastralgia and was diagnosed with two large fusiform inferior PDAAs and celiac axis occlusion. To preserve the blood flow of the pancreatic head, duodenum, liver, and spleen, we performed elective surgery to release the MAL along with aortosplenic bypass. At 6 days postoperatively, transcatheter arterial embolization was performed. At the 8-year 6-month follow-up observation, no recurrent perfusion of the embolized PDAAs or rupture had occurred, including the non-embolized small PDAA, and the bypass graft had excellent patency. Case 2 A 39-year-old man who had been in good health was found to have a PDAA with celiac stenosis during a medical checkup. Computed tomography and superior mesenteric arteriography showed severe celiac axis stenosis and a markedly dilated pancreatic arcade with a large saccular PDAA. To preserve the blood flow of the pancreatic arcade, we performed elective surgery to release the MAL along with aortosplenic bypass. At 9 days postoperatively, transcatheter arterial embolization was performed. At the 6-year 7-month follow-up observation, no recurrent perfusion or rupture of the PDAA had occurred, and the bypass graft had excellent patency. Conclusion Combined treatment with bypass surgery and coil embolization can be an effective option for the treatment of PDAAs associated with celiac axis occlusion or severe stenosis.https://doi.org/10.1186/s40792-021-01260-1Bypass surgeryEmbolizationPancreaticoduodenal artery aneurysm |
| spellingShingle | Shuhei Kii Hirofumi Kamachi Daisuke Abo Takuya Kato Yousuke Tsuruga Kenji Wakayama Tatsuhiko Kakisaka Takeshi Soyama Toshiya Kamiyama Tomonori Ooka Satoru Wakasa Akinobu Taketomi Combined treatment of an aortosplenic bypass followed by coil embolization in the treatment of pancreaticoduodenal artery aneurysms caused by median arcuate ligament compression: a report of two cases Surgical Case Reports Bypass surgery Embolization Pancreaticoduodenal artery aneurysm |
| title | Combined treatment of an aortosplenic bypass followed by coil embolization in the treatment of pancreaticoduodenal artery aneurysms caused by median arcuate ligament compression: a report of two cases |
| title_full | Combined treatment of an aortosplenic bypass followed by coil embolization in the treatment of pancreaticoduodenal artery aneurysms caused by median arcuate ligament compression: a report of two cases |
| title_fullStr | Combined treatment of an aortosplenic bypass followed by coil embolization in the treatment of pancreaticoduodenal artery aneurysms caused by median arcuate ligament compression: a report of two cases |
| title_full_unstemmed | Combined treatment of an aortosplenic bypass followed by coil embolization in the treatment of pancreaticoduodenal artery aneurysms caused by median arcuate ligament compression: a report of two cases |
| title_short | Combined treatment of an aortosplenic bypass followed by coil embolization in the treatment of pancreaticoduodenal artery aneurysms caused by median arcuate ligament compression: a report of two cases |
| title_sort | combined treatment of an aortosplenic bypass followed by coil embolization in the treatment of pancreaticoduodenal artery aneurysms caused by median arcuate ligament compression a report of two cases |
| topic | Bypass surgery Embolization Pancreaticoduodenal artery aneurysm |
| url | https://doi.org/10.1186/s40792-021-01260-1 |
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