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Pancreaticoduodenal artery aneurysm associated with median arcuate ligament syndrome

Marc B Armstrong1, Kevin S Stadtlander1, Mark K Grove2

  • 1Department of Interventional Radiology, Cleveland Clinic Florida, Weston, FL.

Annals of Vascular Surgery
|February 6, 2014
PubMed

Insights

A rare pancreaticoduodenal artery aneurysm associated with median arcuate ligament syndrome was found in a young woman. This case highlights a unique presentation of median arcuate ligament syndrome and pancreaticoduodenal artery aneurysms.

Area of Science:

  • Vascular Surgery
  • Interventional Radiology
  • Gastroenterology

Background:

  • Pancreaticoduodenal artery aneurysms often associate with celiac axis occlusion, typically due to atherosclerosis.
  • Median arcuate ligament syndrome can cause celiac artery compression, but is less common and may present asymptomatically.
  • Aneurysms in this region are rarely reported, especially in younger individuals.

Observation:

  • A 25-year-old woman, evaluated for kidney donation, was incidentally found to have a pancreaticoduodenal artery aneurysm via computed tomography angiography (CTA).
  • The CTA also revealed severe celiac axis compression, attributed to the median arcuate ligament.
  • Catheter angiography confirmed both the aneurysm and the median arcuate ligament compression.

Findings:

  • The patient was asymptomatic, with the aneurysm and median arcuate ligament syndrome discovered incidentally.
  • Successful endovascular coil embolization was performed to treat the pancreaticoduodenal artery aneurysm.
  • This represents the youngest reported case of a pancreaticoduodenal artery aneurysm secondary to median arcuate ligament syndrome.

Implications:

  • This case expands the known age spectrum for median arcuate ligament syndrome presenting with pancreaticoduodenal artery aneurysms.
  • It underscores the importance of considering vascular anomalies in young, asymptomatic individuals undergoing imaging for other reasons.
  • The successful endovascular management demonstrates a viable treatment option for such rare presentations.

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