•Zimmermann, Wilkins, Weaver, Tracci, Clouse

Title: Pancreaticoduodenal artery aneurysms in association with celiac artery pathology: the spectrum of presentation and management

Body:

Pancreaticoduodenal artery aneurysms (PDAA) are highly morbid and can occur in the setting of celiac artery pathology. This is believed to be related to increased flow through the pancreaticoduodenal (PD) arcade for perfusion of the celiac axis. Therefore management must take into consideration celiac and mesenteric abnormalities aiming to normalize proximal perfusion of the PD arcade while maintaining mesenteric and celiac perfusion. Two cases of PDAA in association with celiac artery pathology are presented. Case 1 involves a 71-year-old man with an incidental 4.4cm PDAA in association with proximal celiac artery occlusion. He underwent hybrid aorto-hepatic bypass with 8 mm Dacron and coil embolization of the PDAA. Case 2 is a 55-year-old man presenting with progressive abdominal pain radiating to the back. CTA demonstrated proximal celiac artery dissection and ruptured PDAA. He was treated with coil embolization of the aneurysm with celiac/common hepatic artery stenting. Both patients had unremarkable post-operative recovery. Management of PDAA may require creative approaches with endovascular and open techniques when occurring in the setting of celiac artery pathology. The pancreaticoduodenal artery provides an important collateral between the superior mesenteric artery and the celiac artery which likely contributes to the formation of aneurysms in the setting of celiac occlusion or dissection. The overall strategy must include exclusion of the aneurysm, usually via embolic techniques, due to risk of rupture and restoring perfusion to the celiac axis.

Relevant history:

per abstract body

Relevant test results:

CT scans and angiograms from both cases

Teaching points:

The management of PDAs requires creative solutions to exclude the aneurysm and address celiac axis inflow using a variety of open and endovascular techniques.