ANEURYSM OF THE PANCREATICODUODENAL ARTERY (PDA) - SUCCESSFUL OPEN VASCULAR SURGERY AND CO-FOUNDING CLOSURE OF THE CELIAC TRUNK f.meyer@med.ovgu.de

PE055

ANEURYSM OF THE PANCREATICODUODENAL ARTERY (PDA) - SUCCESSFUL OPEN VASCULAR SURGERY AND CO-FOUNDING CLOSURE OF THE CELIAC TRUNK

7

 

 

 

 

Germany

Poster Exhibition only

Visceral artery aneurysm (VAA) is a rare condition.

Scientific case report, reflecting also relevant references from the literature.

(case description): A 52-year-old woman was referred in elevated liver enzymes for upper abdominal CT scan with contrast agent (pancreaticoduodenal artery [PDA] aneurysm, size: 2.7x2.7 cm; occlusion of the celiac trunk). Initially, an attempt of image-guided embolization (minimally invasive intervention as a first therapeutic step) was unsuccessful since the aneurysm was within the retrograde coeliac trunk's blood supply area via gastroduodenal artery (originating) from the superior mesenteric artery (SMA). Therefore, open vascularsurgical reconstruction was performed comprising i) an autologous supraceliac aortohepatic bypass (using saphenous vein), ii) resection of the aneurysm (aneurysmectomy) and iii) end-to-end anastomosis of the PDA (diameter, 4 mm). The postoperative course was uneventful except for paralytic ileus (successfully managed with conservative measures). Currently, the patient complains on symptoms of gastroparesis. Histology: No significant inflammation/malignancy. The architecture of the vessel wall is significantly disrupted at several points and the elastic basic fibrous structure is tattered.

Indication for an approach to the presented aneurysmal configuration was fully justified due to a size >2 cm. The treatment of VAAs requiring (open) surgery is challenging. The formation of an aneurysm of the PDA could be a consequence of the increased compensatory blood flow from the SMA through the peripancreatic arcade to the liver perfusion due to stenosis or occlusion of the coeliac trunk with subsequent aneurysmal degeneration, so that reconstruction of the celiac trunk appears reasonable (and actually indispensable) to prevent recurrence.