Celiac Artery Aneurysm Research Articles

Celiac Artery Aneurysm With Dissection

A 52-year-old male with no history of vascular disease presented with a celiac artery aneurysm. Incidentally, a celiac artery dissection was discovered. The dissection was a result of the aneurysm. The proximal abdominal aorta, celiac artery, and superior mesenteric artery were examined with gray scale, color flow, and spectral Doppler. The proximal abdominal aorta, celiac artery, and superior mesenteric artery were without evidence of atherosclerotic plaque. There was evidence of a celiac artery aneurysm measuring 1.3 cm, which was stable compared with a previous CT (computed tomography) from April 2014. A dissection was visualized within the celiac artery with color flow aliasing and higher velocities visualized in the false lumen, with the highest measuring 402/142 cm/s. The true lumen highest velocity measured 209/56 cm/s. The superior mesenteric artery was patent with normal flow patterns and velocities measuring from 134 to 189 cm/s. Celiac artery aneurysms and dissections are extremely rare and can be difficult to find and treat. By scanning the aneurysm, the dissection could be found, perhaps reducing the risk of embolus or occlusion.

Recurrent Hematemesis in a Patient With Aorto-enteric Fistula

We report a case of an aorto-enteric fistula (AEF) in a patient with history of celiac artery aneurysm and graft repair. AEFs are a communication between the aorta and the adjacent gastrointestinal tract. AEFs are a rare, but life-threatening cause of upper gastrointestinal tract bleeding and should be on the differential in patients with history of abdominal vascular surgery. A 32-year-old woman underwent celiac artery aneurysm resection with aorto-common hepatic artery graft interposition. This was complicated by pancreatic head, common bile duct, and portal vein necrosis requiring Whipple pancreaticoduodenostomy, Roux-en-Y hepaticojejunostomy, and portal vein resection with graft interposition. She also developed a pancreatico-cutaneous fistula, eventually closed by EUS-guided pancreatic pseudocyst gastrostomy. The patient was later reassessed with EGD, which showed a gastro-jejunal (GJ) junction Forrest class III ulcer. The patient presented to our institution with hematemesis, melena, and hemoglobin of 4.2 g/dL. EGD showed the known GJ ulcer with new friability and was treated with epinephrine and argon plasma coagulation. However, the patient returned with hematemesis and repeat EGD showed the GJ ulcer had an adherent clot with a visible vessel which was clipped. Abdominal CT angiography (CTA) did not reveal evidence of acute hemorrhage. The patient returned with GI bleeding and repeat abdominal CTA showed a tubular structure concerning for AEF, with possible erosion of the celiac stump into the jejunal blind limb. Vascular surgery was consulted for endovascular graft of the AEF. AEFs can be spontaneous or secondary to a previous aortic surgery. Aortic pseudoaneurysms and/or grafts can cause fistula through aortic pulsation into the intestinal tract and present with GI bleeding. EGD, CT with contrast, and CTA are the most common imaging modalities that aid in diagnosis. EGD can be useful if a graft or pulsatile mass is visualized, but most AEFs occur in the distal duodenum and may not be seen on EGD. CT with contrast is relatively sensitive for signs of AEF such as loss of peri-aortic fat pad, gas around the graft, fluid or soft tissue collection around the aorta, and IV contrast extravasation into the bowel or around the aorta. As in our case, CTA can be helpful in patients with altered anatomy. In addition to CT findings typical for AEF, CTA has greater spatial resolution allowing better visualization of the aortic contour and side branches.Figure: Gas shadow and inflammation surrounding aorta at the level of celiac stump, likely indicative of anastomotic connection to walled off necrosis, which is adjacent to the jejunum.

Isolated celiac artery aneurysm: A case report

Celiac artery aneurysms (CAAs) account for 4% of all visceral arteries aneurysms. They are rare, vascular lesions, usually asymptomatic and recognized coincidentally while searching for causes of abdominal pain or other intra abdominal problems. Their significance is in their potential to rupture, which can lead to death. CAAs have no gender predilection, with most manifesting during the fifth decade of life. The diagnosis of these rare aneurysms is being established more frequently as our use of cross-sectional imaging increases. We present the case of isolated celiac artery aneurysm diagnosed incidentally by routine ultrasonography (USG) of abdomen for lower abdominal pain, followed by three dimensional CT angiography of abdomen in a 65-year-old female.

A Case of Vertebro-vertebral Arteriovenous Fistula Clinically Diagnosed as Segmental Arterial Mediolysis Complicated by Celiac Artery Aneurysm Suspected in a State of Impending Rupture

A Case of Vertebro-vertebral Arteriovenous Fistula Clinically Diagnosed as Segmental Arterial Mediolysis Complicated by Celiac Artery Aneurysm Suspected in a State of Impending Rupture

Endovascular treatment of coexistent superior mesenteric artery aneurysm and celiac artery aneurysm

Endovascular treatment of coexistent superior mesenteric artery aneurysm and celiac artery aneurysm

Hemosuccus Pancreaticus: An Unusual Cause of Gastrointestinal Bleeding

Introduction: Hemosuccus pancreaticus is a very rare cause of gastrointestinal (GI) bleeding, usually reported in patients with chronic pancreatitis, pancreatic tumors and pseudocysts. We describe a case of hemosuccus pancreaticus from a gastroduodenal artery aneurysm's bleeding. Case description: 50 year old male with no past medical history presented to the hospital, after a syncopal episode causing a motor vehicle accident. He complained of progressive fatigue and melena for one week. On exam, his vitals were stable. Physical exam showed pale conjuctiva. Laboratories showed hemoglobin of 3 mg/dl. Liver profile, coagulation panel and basic metabolic panel were normal. CT abdomen showed multiple hemorrhagic cysts in pancreas and splenic vein thrombosis. Patient received appropriate blood transfusions. Upper endoscopy revealed non bleeding gastric varices and gastritis. Hospital stay was complicated with hemoglobin drop, requiring daily transfusions. Single ballon push enteroscopy was done, and after three attempts, bleeding in to the ampulla of Vater was identified. The patient underwent angiogram. Bleeding from gastroduodenal artery aneurysm was found, which was coiled to stasis. Discussion: Hemosuccus pancreaticus is defined as hemorrhage into pancreatic duct. It is an extremely rare cause of GI bleeding. It is almost always seen in association with chronic pancreatitis, pseudocysts and tumors. Most common cause of bleeding is from splenic artery aneurysm, however bleeding from pseudocysts, celiac artery, gastroduodenal artery and pancreaticoduodenal artery aneurysms into the pancreatic duct have also been reported. It is associated with high mortality rates if untreated. Diagnosis is made by visualization of bleeding from pancreatic duct during endoscopy. Angiography can identify the source of bleeding if performed during active hemorrhage. If angiography is negative or treatment is not feasible, surgery should be considered emergently. Our patient had a history of alcohol abuse without any previous episode of pancreatitis. During his hospitalization he had intermittent bleeding that made his diagnosis difficult. Hemosuccus pancreaticus should be suspected as a cause of GI bleeding in patients with history of chronic pancreatitis or imaging evidence of pancreatic cysts or tumors. Upper GI endoscopy or angiography during active hemorrhage aids in diagnosis. Endovascular coiling is the treatment of choice in patients with known source of bleeding.

Endovascular Repair of Concomitant Celiac and Splenic Artery Aneurysms Using a Combination of Coil Embolization and Aortic Cuff Stent Graft

Visceral artery aneurysms comprise a small portion of all peripheral vascular aneurysms. Of these, the splenic artery is most commonly affected, while celiac artery involvement is rare. Repair is recommended for symptomatic aneurysms or those exceeding two centimeters in diameter. Most reported repairs for celiac artery aneurysms involve surgical excision with or without bypass grafting, but endovascular treatments are becoming more common. We present a case of a 75 year-old male with proximal celiac and distal splenic artery aneurysms treated with combined percutaneous coil embolization and aortic cuff stent graft placement. The splenic aneurysm sac and proximal splenic artery were coil embolized. Attempts to place a covered stent across the celiac artery aneurysm were unsuccessful from both femoral and brachial approaches. We then coil embolized the celiac artery distal to the aneurysm but proximal to the gastroduodenal branch. Coils were also placed into the celiac artery aneurysm sac and left gastric artery. There was insufficient neck length to place coils into the proximal celiac artery. Consequently, an aortic cuff stent graft was deployed across celiac artery origin to obliterate the inflow. There was no liver dysfunction afterwards due to retrograde flow through a patent gastroduodenal artery.

An isolated spontaneous dissecting celiac artery aneurysm with successful endovascular treatment using stenting and coil embolization

Isolated spontaneous dissecting celiac artery aneurysm (DCAA) is a rare event. We report the case of a 50-year-old Japanese man with sudden post-prandial epigastric pain. He was diagnosed as having an isolated DCAA based on the results of contrast-enhanced multi-slice computed tomography (CT). Initially, we gave him conservative therapy, but the aneurysm grew and then we performed endovascular treatment. The DCAA did not cause a rupture, and there were rich collateral channels between the superior mesenteric artery and the common hepatic artery. However, the neck of the aneurysm was too broad to indwell coils, and it was thought that coils might drop out from the aneurysm. We chose endovascular therapy with a self-expanding stent and coil embolization, and the aneurysm was extinguished. He was successfully treated and has recovered favorably. To our knowledge, few cases of a DCAA treated with both a self-expanding stent and coil embolization have been reported and this strategy may be one of the endovascular treatment options for a DCAA. More data accumulation of this method and investigation of long-term treatment effect are required in the future.<Learning objective: A dissecting celiac artery aneurysm is a rare event. Conservative, endovascular, and surgical therapies have been described, but no optimum treatment exists. For the present patient, we chose endovascular therapy with a stent and coil embolization, and he was successfully treated. To our knowledge, few cases of this condition treated with both stenting and coiling have been reported. We suggest that this strategy be one of the endovascular treatment options for this condition.>

Endovascular Repair of Celiac Artery Aneurysm with the Use of Stent Grafts

PurposeTo determine the feasibility, safety, and long-term outcome of stent-graft insertion for endovascular repair of celiac artery aneurysm (CAA). Materials and MethodsFrom January 2010 to April 2015, 10 patients (three men and seven women; mean age, 51.6 y ± 12.1; age range, 39–81 y) with CAAs underwent endovascular repair via stent-graft insertion in a single center. During treatment, the stent graft was placed at the celiac and common hepatic arteries. Standard follow-up protocol included abdominal CT angiography and clinical examinations at 1, 3, 6, and 12 months and annually thereafter. Follow-up was performed every 2–3 months via telephone for the duration of the follow-up period to confirm patients’ general condition. Data on patient characteristics, technical success, procedure-related complications, and follow-up were collected and analyzed retrospectively. ResultsCAA was successfully sealed by the stent graft in all patients. The common hepatic artery was patent after stent insertion in all patients, and no procedure-related complication occurred. All patients were followed up for 1–64 months (mean, 19.3 mo ± 18.9). Abdominal CT angiography demonstrated no endoleak, stent obstruction, or splenic infarction during follow-up. All patients experienced CAA shrinkage with formation of thrombi or increase in the quantity of thrombi in the CAA sac. ConclusionsStent-graft insertion is a safe and effective method for endovascular repair of CAA.

Symptomatic Celiac Artery Aneurysm Managed with Celiac Plexus Ablation

Symptomatic Celiac Artery Aneurysm Managed with Celiac Plexus Ablation

Spontaneous Isolated Dissecting Aneurysm of Distal Celiac Artery- A Rare and Lethal Incidental Finding

Aneurysm of celiac artery is an uncommon occurrence with nearly 180 cases being reported in the literature so far [1]. These have been attributed to traumatic, iatrogenic and inflammatory being amongst few associated etiological factors. Spontaneous isolated dissecting aneurysm of celiac trunk is a rare occurrence with very few cases being mentioned in the published literature. Although the rate of rupture was 72% to 87% during the 1st half of the 20th century, advances in diagnostic imaging and early surgical intervention have reduced the rupture rate to 7% in recent years [1]. Early recognition and urgent intervention is required to prevent fatal complications like intraperitoneal rupture. Authors present a case of isolated spontaneous dissecting aneurysm of distal celiac artery in a fifty five year old male patient with alcoholic cirrhosis.

Mycotic Celiac Artery Aneurysm: A Case Report, Approach Options, and Review of the Literature

Mycotic Celiac Artery Aneurysm: A Case Report, Approach Options, and Review of the Literature

Visceral Artery Aneurysms

Although rare, visceral artery aneurysms are being increasingly identified with the widespread use of advanced imaging techniques. Their incidence, based on routine autopsies, has been estimated at 0.01 to 0.2% but is thought to be increasing with the rise in percutaneous biliary procedures, endovascular chemoembolization therapies, liver transplantation, arterial trauma secondary to laparoscopic manipulation of vessels, and a trend toward nonoperative management of blunt liver trauma. The morbidity and mortality associated with visceral aneurysms remain high—up to 22% in some reports. Therefore, early recognition and treatment prior to rupture are a priority. Management is evolving and includes open repair, laparoscopic and robotic-assisted repair, and a more important role for endovascular therapies. This review covers splenic artery aneurysms, hepatic artery aneurysms, superior mesenteric artery aneurysms, celiac artery aneurysms, and gastroduodenal and pancreaticoduodenal artery aneurysms. Tables highlight the estimated frequency of aneurysms by anatomic distribution, current management options, etiology of splanchnic artery aneurysms, average visceral artery diameters, and preoperative imaging options. Angiographic images and intraoperative photos are provided. This review contains 12 figures, 5 tables, and 25 references.

Emergency Treatment of Haemorrhaging Coeliac or Mesenteric Artery Aneurysms and Pseudoaneurysms in the Era of Endovascular Management

Patients requiring emergency treatment of visceral artery aneurysms (VAAs) can be treated by endovascular or surgical techniques. Outcomes after failed attempts at endovascular control are unclear as is the present role of surgery. This study reviewed treatment and outcomes of a contemporary cohort of patients with symptomatic VAAs at a tertiary referral centre. Patients undergoing emergency treatment of a VAA of the coeliac, mesenteric arteries, or their branches were identified over a 5-year period. Patient variables, treatments, and outcomes were assessed. Forty-eight patients underwent 65 radiological and two surgical procedures. Pseuodaneuryms were present in 45 (94%) of patients. Interventional radiology procedures were the initial treatment in every patient. The initial success was 40 out of 48 (83%). Patients requiring more than one procedure were all successfully treated. Regarding initial failures, if the VAA sac could not be accessed at angiography an alternative procedure to control the VAA was required in every case. If initial endovascular treatment failed, repeating the same procedure was successful in half of the patients. Ultrasound-guided percutaneous VAA embolisation was used in four patients. The 30-day mortality was eight out of 48 (17%). There were four recorded complications including one death directly attributable to VAA treatment. Patients needing emergency treatment of a VAA could be well served by non-surgical management. When the initial attempt at control of bleeding is unsuccessful it is important to consider non-conventional means of accessing these arteries. The need for surgery, in selected centres, may exist for a small group of patients after initial failed radiological treatment only.

Celiac Artery Aneurysm with Celiacomesenteric Trunk: Report of a Case

Celiac Artery Aneurysm with Celiacomesenteric Trunk: Report of a Case

Celiac Artery Aneurysm Due to Chronic Spontaneous Dissection: Two Cases of Surgical Repair

In this report, we describe two surgical cases of celiac artery aneurysm due to chronic and asymptomatic spontaneous dissection without atherosclerotic change or medial degeneration. Case 1 had replacement of the celiac and common hepatic arteries using a knitted Dacron prosthetic graft, and case 2 had simple aneurysmectomy. The incidence of celiac artery dissection is increasing lately, but subsequent aneurysm is relatively rare. Our two cases had no atherosclerotic risk factors, so it might be possible that celiac artery aneurysm due to spontaneous dissection may produce different findings from dissection of other arteries. We consider that the need for surgery should be determined carefully if the asymptomatic celiac artery aneurysm due to dissection is small and unless it shows any changes in its diameter in the follow-up period.

A Case of Celiac Artery Aneurysm Successfully Treated with Endovascular Stent-Graft Placement

A Case of Celiac Artery Aneurysm Successfully Treated with Endovascular Stent-Graft Placement

Celiac trunk aneurysm in a patient with Adamantiades-Behçet disease

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

Endovascular Treatment of Celiac Artery Aneurysm with a Covered Stent: Case Presentation and Review of the Literature

Endovascular Treatment of Celiac Artery Aneurysm with a Covered Stent: Case Presentation and Review of the Literature

Two-Stage Hybrid Repair of a Complex Symptomatic Celiac Aneurysm

We report the case of a novel 2-stage hybrid repair of a complex celiac artery aneurysm. The patient was a 42-year-old man with a proximal celiac artery aneurysm giving rise to distinct right and left hepatic arterial branches. Repair was performed using a staged approach. First, a bifurcated aortohepatic bypass was constructed to the common and left hepatic arteries. After recovering from surgery, he underwent percutaneous embolization of the aneurysm. Completion angiograms demonstrated flow into all celiac branches with successful thrombosis of the aneurysm. At 12-month follow-up, the patient had remained symptom-free with patent bypass grafts and complete aneurysm exclusion. We describe the treatment option we used, which involves repair of a complex celiac aneurysm using a 2-stage, open, endovascular approach.