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Management of Pancreaticoduodenal Artery Aneurysms: Results of Superselective Transcatheter Embolization

Satoru Murata1, Hiroyuki Tajima1, Tsuyoshi Fukunaga1, Yutaka Abe1, Pascal Niggemann2, Shiro Onozawa1, Tatsuo Kumazaki1, Masayuki Kuramochi3 and Kemmei Kuramoto4

1 Department of Radiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyou-ku, Tokyo, Japan 113-8602.
2 Department of Radiology, RWTH Aachen University Hospital, Aachen, Germany.
3 Department of Radiology, Hitachi General Hospital, Hitachi, Ibaragi, Japan.
4 Department of Diagnostic Radiology, National Disaster Medical Center, Tokyo, Japan.


Figure 1
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  		Fig. 1A —72-year-old woman with embolization of nonruptured pancreaticoduodenal artery aneurysm caused by celiac axis stenosis. Contrast-enhanced CT scan reveals aneurysm (2.8 cm in diameter) located behind pancreas head.

 

Figure 2
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  		Fig. 1B —72-year-old woman with embolization of nonruptured pancreaticoduodenal artery aneurysm caused by celiac axis stenosis. Angiography of superior mesenteric artery shows pancreaticoduodenal artery aneurysm of inferior pancreaticoduodenal artery. Hepatic arteries and splenic artery are opacified through dilated dorsal pancreas artery as main feeder. Afferent artery of aneurysm is embolized through superior mesenteric artery route, and efferent artery is also embolized through celiac artery route.

 

Figure 3
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  		Fig. 1C —72-year-old woman with embolization of nonruptured pancreaticoduodenal artery aneurysm caused by celiac axis stenosis. Superior mesenteric arteriography after embolization of aneurysm shows no visualized aneurysm.

 

Figure 4
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  		Fig. 1D —72-year-old woman with embolization of nonruptured pancreaticoduodenal artery aneurysm caused by celiac axis stenosis. Contrast-enhanced CT scan 1 week after transcatheter arterial embolization shows complete thrombosis of the aneurysm.

 

Figure 5
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  		Fig. 2A —53-year-old man with embolization of multiple ruptured pancreaticoduodenal artery aneurysms. Superior mesenteric arteriogram shows four aneurysms.

 

Figure 6
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  		Fig. 2B —53-year-old man with embolization of multiple ruptured pancreaticoduodenal artery aneurysms. Selective inferior pancreaticoduodenal arteriogram clearly shows aneurysms, three on the pancreaticoduodenal artery (arrows) and one on first jejunum artery (arrowhead).

 

Figure 7
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  		Fig. 2C —53-year-old man with embolization of multiple ruptured pancreaticoduodenal artery aneurysms. Gastroduodenal artery arteriogram after embolization with microcoils (arrows) and gelatin sponge particles shows no extravasation and no visualized aneurysms.

 

Figure 8
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  		Fig. 3A —54-year-old man with embolization of ruptured pancreaticoduodenal artery aneurysms caused by celiac axis stenosis. Unenhanced CT scan shows retroperitoneal hematoma.

 

Figure 9
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  		Fig. 3B —54-year-old man with embolization of ruptured pancreaticoduodenal artery aneurysms caused by celiac axis stenosis. Selective superior mesenteric arteriogram shows two aneurysms, 3.3 cm and 0.5 cm in diameter, arising from anterior inferior pancreaticoduodenal artery.

 

Figure 10
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  		Fig. 3C —54-year-old man with embolization of ruptured pancreaticoduodenal artery aneurysms caused by celiac axis stenosis. Selective superior mesenteric arteriogram after embolization with microcoils (arrows) shows no visualized aneurysms.

 

Figure 11
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  		Fig. 3D —54-year-old man with embolization of ruptured pancreaticoduodenal artery aneurysms caused by celiac axis stenosis. Contrast-enhanced CT scan 4 weeks after embolization shows no hematoma in abdominal cavity.

 

Figure 12
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  		Fig. 4A —58-year-old man with pancreaticoduodenal aneurysm rupture caused by median arcuate ligament syndrome. Contrast-enhanced CT scan shows hematoma surrounding duodenum in retroperitoneal space.

 

Figure 13
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  		Fig. 4B —58-year-old man with pancreaticoduodenal aneurysm rupture caused by median arcuate ligament syndrome. Selective superior mesenteric arteriogram shows saccular aneurysm (arrow), 3.2 cm in diameter, arising from anterior inferior pancreaticoduodenal artery. Celiac axis is completely occluded and blood flow to liver and spleen is supplied by way of enlarged pancreaticoduodenal artery.

 

Figure 14
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  		Fig. 4C —58-year-old man with pancreaticoduodenal aneurysm rupture caused by median arcuate ligament syndrome. Contrast-enhanced CT scan obtained 2 weeks after embolization of only afferent artery shows well-enhanced aneurysm with mural thrombus (arrows).

 

Figure 15
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  		Fig. 5A —53-year-old man with embolization of ruptured pancreaticoduodenal artery aneurysm caused after surgery. Arteriogram via gastroduodenal artery shows extravasation (arrows) from posterior superior pancreaticoduodenal artery. Metallic coils (arrowheads) were placed in patient at another hospital.

 

Figure 16
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  		Fig. 5B —53-year-old man with embolization of ruptured pancreaticoduodenal artery aneurysm caused after surgery. Selective posterior superior pancreaticoduodenal arteriography reveals ruptured aneurysm (arrow) and contrast media flow into abdominal cavity.

 

Figure 17
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  		Fig. 5C —53-year-old man with embolization of ruptured pancreaticoduodenal artery aneurysm caused after surgery. Selective posterior superior pancreaticoduodenal arteriogram after embolization with coil (arrow) shows no visualized aneurysm or bleeding.

 

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