Abstract
Pancreaticoduodenal artery (PDA) aneurysm and celiac artery (CA) stenosis are rare diseases in themselves. Interestingly, however, there are more cases documented in the literature in which these two disease entities occurred together than could be coincidental, and CA stenosis has been suggested as the provocative condition in developing PDA aneurysm. This study is aimed at examining the causal relationship between CA stenosis and PDA aneurysm by simulating the splanchnic circulation with an electric circuit. A patient with multiple PDA aneurysms and collaterals with CA stenosis was treated in our institution using hybrid techniques. The patient's pre- and postoperative status was simulated using an electric circuit, and the two possible scenarios were tested for compatibility: the stenosis-first scenario vs. the aneurysm-first scenario. The simulation was performed in two ways: using Simulink® software (MATLAB® Release 2018b) and actual circuit construction on a breadboard. The stenosis-first scenario showed that as the CA stenosis progresses, the blood flow through PDA increases, favoring the development of an aneurysm and/or collaterals if the artery was already compromised by a weakening condition. On the other hand, the aneurysm-first scenario also showed that if the aneurysm or collaterals developed first, the aneurysm will steal the blood flow through the CA, causing it to collapse if the artery was already compromised by increased wall tension. Contrary to the common belief, this study showed that in patients suffering from concurrent CA stenosis and PDA aneurysm, either condition could develop first and predispose the development of the other. The simulation of splanchnic blood flow with an electric circuit provides a useful tool for analyzing rare vascular diseases that are difficult to provoke in clinical and animal studies.
Highlights
Visceral artery aneurysm (VAA) is a rare but potentially lethal disease with diverse causes [1,2,3]
It is generally believed that the increase in the collateral flow due to stenosis or occlusion of the major aortic branches causes aneurysmal dilatation of the representative arteries [5, 7, 8]
From 1 to 2 sec, the resistance of celiac artery (CA) stenosis increased from 0 Ω to 50 kΩ to simulate the development of stenosis, while that of pancreaticoduodenal artery (PDA) aneurysm remained at 50 kΩ
Summary
Visceral artery aneurysm (VAA) is a rare but potentially lethal disease with diverse causes [1,2,3]. Pancreaticoduodenal artery (PDA) aneurysms are commonly accompanied by celiac artery (CA) stenosis or occlusion, which is rare [5, 6]. It is unclear whether the relationship between VAA aneurysm and aortic take-off vascular stenosis is causal or coincidental [7]. The electric simulation model was run by simulation software and actual electric circuit construction on a breadboard. Using this simulation, we show which event came first, the stenosis or the aneurysm.
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