Abstract No. 425 A utility of the endovascular treatment for ruptured or unruptured aneurysms of the pancreaticoduodenal arcade

Abstract

The aneurysms of pancreaticoduodenal arcade (PArc-Ans), including gastroduodenal artery aneurysms (GDAAs) and pancreaticoduodenal artery aneurysms (PDAAs), are uncommon lesions associated with a significant risk of rupture. The purpose of this study was to evaluate the utility of endovascular treatment for PArc-Ans. The records of all patients with GDAAs and PDAAs treated by transcatheter arterial embolization (TAE) between 2010 and 2016 were identified through an institutional datebase, and these records were retrospectively reviewed. Date on presenting symptoms, comorbid conditions, imaging findings, treatment approach, complications, observation period, and outcomes after treatment were examined. All patients were successfully treated by transcatheter arterial embolization (TAE) [two GDAAs (size; 13.9 mm, range; 13.3-14.4 mm) and 10 PDAAs (size; 11.2 mm, range; 4.3-26.8 mm)]. Three symptomatic aneurysms (25%) were only found in three ruptured patients who were all successfully treated by TAE. Six patients were associated with sever stenosis or complete occlusion of celiac axis due to the compression by median arcuate ligament. Most of them (5/6) were successfully treated by TAE alone. A patient with complete occlusion of celiac axis and multiple PDAAs were treated with a combination of TAE and bypass surgery. The average observation period after treatment was 14.9 months (range, 1-45 months). Overall 30-day morbidity and mortality after treatment were both 0.0%. The TAE could be recognized as a safe and effective treatment technique for PArc-Ans with or without rupture.