Repair of an extensive, dissecting coeliac artery aneurysm by an endovascular approach

Abstract

Coeliac artery aneurysms are rare but potentially fatal lesions, that if remain undetected are liable to rupture with imminent mortality. We present a case of a dissecting coeliac artery aneurysm in a 62-year-old man who presented with epigastric pain, nausea and vomiting. No obvious aetiological cause could be identified, other than elevated cholesterol as a risk factor for atherosclerotic degeneration. Three-dimensional image reconstruction of multislice helical CT showed the aneurysm extended from its dissection at the coeliac origin into the left and right hepatic and gastroduodenal arteries. Coil embolisation of the affected segments and stenting of the dissection flap with a vascular Genesis stent (Cordis, UK) resolved symptoms without causing ischaemic compromise to the organs supplied by the coeliac axis. Debate still exists over whether the endovascular or surgical approach is the most appropriate first-line treatment. In the haemodynamically stable patient and with access to experienced interventional radiologists, endovascular repair is a viable and comparatively non-invasive option.