Celiac trunk aneurysm in a patient with Adamantiades-Behçet disease

Abstract

Major artery involvement in Adamantiades-Behcet disease (ABD) ranges from 5% to 18% and mainly manifests as arterial stenosis and/or aneurysm formation.1 Celiac artery involvement is considered rare; celiac aneurysms have been reported in isolated cases.2,3 We present computed tomography (CT) angiography of a 70-year-old male, suffering from ABD for 40 years (initial symptoms included recurrent oral and genital ulcerations and bilateral anterior uveitis). Treatment, over time, included methylprednisolone, cyclosporine and azathioprine. He was admitted for severe upper abdominal pain, accompanied by nausea and abdominal distension. Laboratory investigation showed elevated erythrocyte sedimentation rate and C-reactive protein. Abdominal CT angiography revealed a celiac artery aneurysm starting 2 mm from the aorta measuring 32 mm in length and with a maximum diameter of 16.7 mm (Panel A) with thrombus attached in the arterial wall. Additionally, the common hepatic artery was totally occluded; hepatic perfusion was sustained via the superior mesenteric and pancreatoduodenal arteries (Panel B). Intravenous methylprednisolone pulses (1000 mg/day for 5 consecutive days) were administered with satisfactory response. Maintenance treatment included methylprednisolone and mycophenolate mofetil, along with antiplatelet therapy (aspirin plus clopidogrel). After 12 months, repeated abdominal CT angiography revealed stabilization of the celiac artery aneurysm (maximum diameter 16.3 mm). During this period, the patient remained asymptomatic. Celiac artery aneurysm in ABD represents a rare entity and may require combined medical and surgical intervention. Urgent surgery, either by open or endovascular repair, is mandatory in case of enlarging or ruptured aneurysms or due to organ-threatening ischemia.3,4 Equally significant is the implementation of postoperative immunosuppressive therapy, to prevent relapse and common complications after arterial bypass surgery, such as graft occlusion and new aneurysm formation at the site of anastomoses. Remission induction with immunosuppressive drugs represents the first goal in uncomplicated cases of ABD, while Images in Vascular Medicine