Abstract
BackgroundAneurysms of the pancreaticoduodenal arcades are an uncommon pathology, with a prevalence of 2%, and could be congenital or acquired. Treatment of visceral aneurysms is therefore generally recommended when the aneurysmal sac equals or exceeds 2 cm. Wide-necked (> 4 mm) and main artery branch aneurysms represent a challenge for conventional endovascular coil embolization due to the risk of coil migration.Main bodyThis case describes the technical feasibility of balloon-assisted coil embolization (BACE) in the treatment a wide neck aneurysm of inferior pancreatic duodenal artery due to celiac axis occlusion.Short conclusionIn case of celiac trunk occlusion, BACE is a safe procedure associated with optimal technical success rates, in order to treat the aneurysms and to preserve splanchnic vascularization.
Highlights
Aneurysms of the pancreaticoduodenal arcades were described as early as late eighteenth century; true aneurysms of the pancreaticoduodenal arcades are rare and make up only 2% of all splanchnic aneurysms (Kalva et al 2007)
We describe a case of a wide neck of inferior pancreatic duodenal artery aneurysm associated with a celiac trunk occlusion treated with balloon-assisted coil embolization (BACE) in order to treat the aneurysms and to preserve retrograde celiac trunk vascularization through the pancreatic-duodenal arcade
We decided to treat the aneurysmal sac through superior mesenteric artery (SMA). This latter was catheterized with 5F Cobra 2 catheter (Terumo, Tokyo, Japan) and a 0,0035′′ angled guidewire (Terumo, Tokyo, Japan); subsequent DSA obtained from the origin of SMA angiogram confirmed the saccular aneurysm, dilated inferior pancreatic duodenal artery (iPDA) with evidence of revascularization through this branch of the celiac trunk (Fig. 2a)
Summary
Aneurysms of the pancreaticoduodenal arcades were described as early as late eighteenth century; true aneurysms of the pancreaticoduodenal arcades are rare and make up only 2% of all splanchnic aneurysms (Kalva et al 2007). We decided to treat the aneurysmal sac through superior mesenteric artery (SMA) This latter was catheterized with 5F Cobra 2 catheter (Terumo, Tokyo, Japan) and a 0,0035′′ angled guidewire (Terumo, Tokyo, Japan); subsequent DSA (digital subtraction angiography) obtained from the origin of SMA angiogram confirmed the saccular aneurysm, dilated iPDA with evidence of revascularization through this branch of the celiac trunk (Fig. 2a). In order to avoid iPDA embolization and preserve celiac branches, a 6 × 40 mm balloon (MustangTM, Boston Scientific, Cork, Ireland), sized on the basis of CT images, was advanced through the right access and positioned across aneurysm neck; across the left side access, we catheterized the aneurysmal sac with a microcatheter (2.7 F tip Progreat®; Terumo, Tokyo, Japan) (Fig. 2b). The final diagnostic angiography showed completely exclusion of the sac from blood filling with preserved flow through PDA to the celiac axis aneurysmal sac from blood flow with patency of iPDA and preserved vascularization of celiac branches (Fig. 3)
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