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Combined treatment of an aortosplenic bypass followed by coil embolization in the treatment of pancreaticoduodenal artery aneurysms caused by median arcuate ligament compression: a report of two cases

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Title: Combined treatment of an aortosplenic bypass followed by coil embolization in the treatment of pancreaticoduodenal artery aneurysms caused by median arcuate ligament compression: a report of two cases
Authors: Kii, Shuhei Browse this author
Kamachi, Hirofumi Browse this author →KAKEN DB
Abo, Daisuke Browse this author
Kato, Takuya Browse this author
Tsuruga, Yousuke Browse this author
Wakayama, Kenji Browse this author
Kakisaka, Tatsuhiko Browse this author
Soyama, Takeshi Browse this author
Kamiyama, Toshiya Browse this author
Ooka, Tomonori Browse this author
Wakasa, Satoru Browse this author
Taketomi, Akinobu Browse this author →KAKEN DB
Keywords: Bypass surgery
Embolization
Pancreaticoduodenal artery aneurysm
Issue Date: 4-Aug-2021
Publisher: Springer
Journal Title: Surgical case reports
Volume: 7
Issue: 1
Start Page: 174
Publisher DOI: 10.1186/s40792-021-01260-1
Abstract: Background Pancreaticoduodenal artery aneurysms (PDAAs) are rare visceral aneurysms, and prompt intervention/treatment of all PDAAs is recommended at the time of diagnosis to avoid rupture of aneurysms. Herein, we report two cases of PDAA caused by the median arcuate ligament syndrome, treated with surgical revascularization by aortosplenic bypass followed by coil embolization. Case presentation Case 1 A 54-year-old woman presented with a chief complaint of severe epigastralgia and was diagnosed with two large fusiform inferior PDAAs and celiac axis occlusion. To preserve the blood flow of the pancreatic head, duodenum, liver, and spleen, we performed elective surgery to release the MAL along with aortosplenic bypass. At 6 days postoperatively, transcatheter arterial embolization was performed. At the 8-year 6-month follow-up observation, no recurrent perfusion of the embolized PDAAs or rupture had occurred, including the non-embolized small PDAA, and the bypass graft had excellent patency. Case 2 A 39-year-old man who had been in good health was found to have a PDAA with celiac stenosis during a medical checkup. Computed tomography and superior mesenteric arteriography showed severe celiac axis stenosis and a markedly dilated pancreatic arcade with a large saccular PDAA. To preserve the blood flow of the pancreatic arcade, we performed elective surgery to release the MAL along with aortosplenic bypass. At 9 days postoperatively, transcatheter arterial embolization was performed. At the 6-year 7-month follow-up observation, no recurrent perfusion or rupture of the PDAA had occurred, and the bypass graft had excellent patency. Conclusion Combined treatment with bypass surgery and coil embolization can be an effective option for the treatment of PDAAs associated with celiac axis occlusion or severe stenosis.
Type: article
URI: http://hdl.handle.net/2115/82986
Appears in Collections:北海道大学病院 (Hokkaido University Hospital) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

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