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Published on: August 14, 2021
Title: Is Celiac Trunk Revascularization Necessary After High-Flow Pancreaticoduodenal Arterial Arcades Aneurysm
Mohamed Salim Jazzar1, Hicham Kobeiter1,2,3, Mario Ghosn1,2
1Medical Imaging Department, Henri Mondor University Hospital Assistance Publique-Hôpitaux de Paris, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France.
Insights
Retrograde embolization effectively treats high-flow pancreaticoduodenal artery aneurysms caused by celiac trunk issues. This minimally invasive approach is safe and avoids the need for celiac trunk revascularization.
Area of Science:
- Vascular Surgery
- Interventional Radiology
Background:
- High-flow pancreaticoduodenal artery (PDA) aneurysms linked to celiac trunk occlusion/stenosis carry a significant rupture risk.
- Embolization presents a less invasive alternative to surgical repair for these aneurysms.
Purpose of the Study:
- To assess the efficacy and safety of retrograde embolization via the superior mesenteric artery for high-flow PDA aneurysms.
- To determine if celiac trunk revascularization is necessary when performing this embolization technique.
Main Methods:
- Retrospective analysis of patients undergoing embolization for high-flow PDA aneurysms due to celiac trunk stenosis or occlusion.
- Pre-interventional dynamic contrast-enhanced computed tomography (CECT) for assessment.
- Retrograde embolization using microcoils and/or liquid agents without celiac trunk revascularization.
- Clinical and radiological follow-up at one month, with longer-term monitoring.
Main Results:
- Technical success rate was 100% in 23 included patients (mean age 65 ± 14 years).
- Clinical success was achieved in 87% of cases, with a median follow-up of 16 months.
- No hemorrhagic recurrences were noted; two minor complications and one major complication (splenic infarction) occurred.
Conclusions:
- Retrograde embolization is a safe and effective treatment for high-flow PDA aneurysms.
- Celiac trunk revascularization is not required for successful retrograde embolization of these aneurysms.
Abstract:
Background and Objective: High-flow pancreaticoduodenal artery (PDA) aneurysms secondary to celiac trunk occlusion or stenosis have a high risk of rupture. Embolization offers a less invasive alternative to surgery. We evaluated the effectiveness and safety of retrograde embolization via the superior mesenteric artery of high-flow PDA aneurysms without celiac trunk revascularization. Methods: This retrospective bicentric study included patients who underwent embolization of high-flow PDA aneurysms due to significant celiac trunk stenosis or occlusion. All patients underwent pre-interventional dynamic contrast-enhanced computed tomography. Retrograde embolization was performed using microcoils and/or liquid agents without celiac trunk revascularization. Follow up involved clinical and radiological assessment at one month. Technical and clinical success were evaluated, and complications were categorized as minor or major. Results: Twenty-three patients (mean age 65 ± 14 years; 52% male) were included. Emergency embolization was required in 12 patients (52%). The technical success rate was 100%. Patients were monitored for a median of 16 months. Clinical success was 87%. No hemorrhagic recurrences were observed. Minor complications occurred in two cases. One major complication involved splenic infarction due to glue migration, requiring splenectomy and intensive unit care admission. Conclusions: Retrograde embolization of high-flow PDA aneurysms is effective and safe without needing celiac trunk revascularization.
