Pancreaticoduodenal Artery Aneurysm in a Patient with Celiac Artery Atresia

Abstract

Visceral artery aneurysms (VAA) have an array of presentations and management strategies. Pancreaticoduodenal artery aneurysms (PDAA) are rare, potentially lethal, and necessitate treatment. We present the case of a PDAA in a patient with a congenitally hypoplastic celiac artery treated by open surgical reconstruction. A 60-year-old female presented with an incidental 2 cm proximal inferior PDAA. Significantly, her celiac trunk was hypoplastic and all flow to hepatic, gastric, and splenic arteries stemmed from a dilated superior mesenteric artery (SMA). The PDAA was located 1 cm from the origin of the pancreaticoduodenal artery at the superior mesenteric artery (SMA) and was adhered to the fourth portion of the duodenum. Considering her anatomy, open repair with reconstruction of the pancreaticoduodenal artery was pursued via a midline laparotomy, resection of the PDAA, and primary end-to-side pancreaticoduodenal artery to SMA reconstruction. There was excellent flow into the PDA, GDA, and their emanating branches intra-operatively and on post-operative imaging. The patient progressed well and was discharged home on post-operative day five. Liver function tests were serially checked and were within normal limits upon discharge. We demonstrate a safe and successful surgical option for patients with PDAA who required preserved GDA flow.