Inferior pancreaticoduodenal artery aneurysm: endovascular approach

Aneurysms of the pancreaticoduodenal arteries are a rare condition. In the majority of cases, diagnosis is made in emergency situations due to complications such as rupture, which is associated with high mortality rates (21-26%). Embolization of the aneurysm sac is the treatment of choice, because of its high efficacy and lower mortality. This article presents and discusses a case of inferior pancreaticoduodenal artery aneurysm that was diagnosed during investigation of gastrointestinal symptoms. The treatment provided was microcoil embolization, with complete exclusion of the aneurysm and a good clinical course.

Keywords:
aneurysm; endovascular procedures; therapeutic embolization

Authorship

Patrick Bastos Metzger

Escola Bahiana de Medicina e Saúde Pública – EBMSP, Salvador, BA, Brasil.Escola Bahiana de Medicina e Saúde PúblicaBrasilSalvador, BA, BrasilEscola Bahiana de Medicina e Saúde Pública – EBMSP, Salvador, BA, Brasil.

http://orcid.org/0000-0002-1717-1370

Kamilla Rosales Costa

http://orcid.org/0000-0003-1920-5666

Simone Lessa e Silva

Obra Sociais Irmã Dulce – OSID, Hospital Santo Antônio, Salvador, BA, Brasil.Obra Sociais Irmã DulceBrasilSalvador, BA, BrasilObra Sociais Irmã Dulce – OSID, Hospital Santo Antônio, Salvador, BA, Brasil.

Alan Costa Gouveia

Hospital Português, Salvador, BA, Brasil.Hospital PortuguêsBrasilSalvador, BA, BrasilHospital Português, Salvador, BA, Brasil.

Murilo Quadro Berbert

Hospital da Bahia – HBA, Salvador, BA, Brasil.Hospital da BahiaBrasilSalvador, BA, BrasilHospital da Bahia – HBA, Salvador, BA, Brasil.

Milton Oliveira de Albuquerque Mello

Hospital da Bahia – HBA, Salvador, BA, Brasil.Hospital da BahiaBrasilSalvador, BA, BrasilHospital da Bahia – HBA, Salvador, BA, Brasil.

Fabrício Mascarenhas de Oliveira

Hospital da Bahia – HBA, Salvador, BA, Brasil.Hospital da BahiaBrasilSalvador, BA, BrasilHospital da Bahia – HBA, Salvador, BA, Brasil.

Ricardo Fernandes Ferraz Melo

Hospital da Bahia – HBA, Salvador, BA, Brasil.Hospital da BahiaBrasilSalvador, BA, BrasilHospital da Bahia – HBA, Salvador, BA, Brasil.

Conflicts of interest:

No conflicts of interest declared concerning the publication of this article.

Correspondence
Patrick Bastos Metzger Escola Bahiana de Medicina e Saúde Pública – EBMSP Alameda de Pádua, 25 - Pituba CEP 41830-480 - Salvador (BA), Brasil Tel.: +55 (71) 99977-6356 E-mail: patrickvascular@gmail.com

Author information

PBM - PhD in Medicina, Universidade de São Paulo; Vascular and endovascular surgeon, Sociedade Brasileira de Angiologia e Cirurgia Vascular e Radiologista Intervencionista, Colégio Brasileiro de Radiologia. KRC - 9th semester medical student, Escola Bahiana de Medicina e Saúde Pública (EBMSP). SLS - Residency preceptor, Geriatria, Hospital Santo Antônio, Obra Sociais Irmã Dulce. ACG - Vascular surgeon, Sociedade Brasileira de Angiologia e Cirurgia Vascular. MQB and MOAM - Vascular and endovascular surgeons, Sociedade Brasileira de Angiologia e Cirurgia Vascular. FMO - Vascular surgeon, Sociedade Brasileira de Angiologia e Cirurgia Vascular; Interventional radiologist, Colégio Brasileiro de Radiologia. RFFM - General surgeon, Ministério da Educação e Cultura.

Author contributions

Conception and design: PBM Analysis and interpretation: KRC, PBM, SLS Data collection: PBM, ACG, MQB, MOAM, RFFM, FMO Writing the article: KRC e PBM Critical revision of the article: PBM Final approval of the article*: KRC, PBM, SLS, ACG, MQB, MOAM, RFFM, FMO Statistical analysis: KRC, PBM, SLS Overall responsibility: PBM *All authors have read and approved of the final version of the article submitted to J Vasc Bras.

SCIMAGO INSTITUTIONS RANKINGS

Hospital Português, Salvador, BA, Brasil.Hospital PortuguêsBrasilSalvador, BA, BrasilHospital Português, Salvador, BA, Brasil.

Hospital da Bahia – HBA, Salvador, BA, Brasil.Hospital da BahiaBrasilSalvador, BA, BrasilHospital da Bahia – HBA, Salvador, BA, Brasil.

Figures

Figures (3)

Thumbnail

Figure 1
(A) Left anterior oblique volumetric angiotomographic reconstruction showing a large inferior pancreaticoduodenal artery aneurysm; (B) Right anterior oblique volumetric angiotomographic reconstruction showing communications with the celiac trunk (CT) via the gastroduodenal artery and with the superior mesenteric artery via the inferior pancreaticoduodenal artery; (C) Axial angiotomographic slice showing the ostial plaque in the CT; (D) Sagittal angiotomographic slice showing the ostial plaque in the CT causing approximately 20% stenosis.

Thumbnail

Figure 2
(A) Arteriography via the superior mesenteric artery (SMA), with selective catheterization; (B) Microcatheter selection of the large aneurysm of the inferior pancreaticoduodenal artery; (C) Selective arteriography of the SMA after embolization with microcoils, showing complete exclusion of the aneurysm sac; (D) Selective arteriography of the celiac trunk after embolization with microcoils, showing complete exclusion of the aneurysm sac.

Thumbnail

Figure 3
Postoperative volumetric angiotomographic reconstruction showing no filling of the aneurysm, which has been completely excluded.

Figure 1 (A) Left anterior oblique volumetric angiotomographic reconstruction showing a large inferior pancreaticoduodenal artery aneurysm; (B) Right anterior oblique volumetric angiotomographic reconstruction showing communications with the celiac trunk (CT) via the gastroduodenal artery and with the superior mesenteric artery via the inferior pancreaticoduodenal artery; (C) Axial angiotomographic slice showing the ostial plaque in the CT; (D) Sagittal angiotomographic slice showing the ostial plaque in the CT causing approximately 20% stenosis.

Figure 2 (A) Arteriography via the superior mesenteric artery (SMA), with selective catheterization; (B) Microcatheter selection of the large aneurysm of the inferior pancreaticoduodenal artery; (C) Selective arteriography of the SMA after embolization with microcoils, showing complete exclusion of the aneurysm sac; (D) Selective arteriography of the celiac trunk after embolization with microcoils, showing complete exclusion of the aneurysm sac.

Figure 3 Postoperative volumetric angiotomographic reconstruction showing no filling of the aneurysm, which has been completely excluded.

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Inferior pancreaticoduodenal artery aneurysm: endovascular approach

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[1] Conflicts of interest:

No conflicts of interest declared concerning the publication of this article.