Keywords:
Vascular, Interventional vascular, CT-Angiography, Catheter arteriography, Diagnostic procedure, Embolisation, Aneurysms
Authors:
R. Antoniak1, L. Grabowska-Derlatka2, R. B. Maciag1, O. Rowinski1; 1Warsaw/PL, 2Warsaw, NO/PL
DOI:
10.26044/ecr2019/C-2355
Methods and materials
We present a series of 21 patients with PAAAs (Fig.
2).
The diagnosis was established by contrast-enhanced CT in all cases.
We evaluated different collateral pathways connecting celiac axis (CA) and superior mesenteric artery (SMA) circulations for presence of aneurysms (anterior pancreaticoduodenal arteries,
posterior pancreaticoduodenal arteries,
dorsal pancreatic artery and gastroepiploic arteries,
Fig.
3).
The aneurysms were characterized by their number,
location,
size and morphology.
We paid special attention to patency of CA and SMA and the most likely cause of their stenosis/occlusion.
Absence of atherosclerotic plaques,
thickened median arcuate ligament (MAL) and typical CA narrowing with a hooked appearance favored compression syndrome (Fig.
4 and 5),
while presence of a significant atherosclerotic plaque in arteries’ ostium favored atherosclerotic etiology.
The two most importing diagnostic considerations were:
1.
What is the etiology of splanchnic arteries’ lesions?
2.
Is there a route connecting CA and SMA circulations free from aneurysms (Fig.
6 and 7)?
Endovascular embolization is the treatment of choice in patients with PAAAs [4,
5].
Maintenance of hepatic perfusion is the main concern of this treatment.
The collateral pathway free from aneurysms would act as a safety valve maintaining hepatic circulation in case of unintentional closure of other routes during treatment.
Therefore,
if either all collateral pathways were affected by aneurysms or significant local factors (eg.
pancreatic head cancer in one patient) occurred,
surgical or combined treatment was preferred.
These strategies included surgical revascularization with simultaneous aneurysms resection or followed by endovascular embolization.
Our management algorithm is summarized in Fig.
8.
Patients were followed up 3-6 months after the procedures and yearly afterwards.