Relationship between peripancreatic collateral circulation development and aneurysm presence in celiac trunk stenosis

Celiac trunk (CeT) stenosis can lead to the development of collateral circulation and aneurysm formation through the pancreatic arteries; however, the relationship between specific collateral patterns and aneurysm development or rupture remains unclear. Here we evaluated the association between collateral circulation characteristics and aneurysm formation in patients with CeT stenosis.

This cross-sectional study included 233 patients with CeT stenosis from a single tertiary care center. The patients were categorized into ruptured aneurysm (n = 24), unruptured aneurysm (n = 105), and stenosis or occlusion without aneurysm (n = 104) groups. Contrast-enhanced computed tomography images were evaluated for collateral circulation patterns, the presence of the arc of Bühler, vessel diameters, and aneurysm characteristics. Multivariate analyses were conducted to identify factors associated with aneurysm presence.

The presence of the arc of Bühler showed the strongest association with aneurysm presence, followed by pancreaticoduodenal arcade (PD arc) development grade. The arc of Bühler was observed in 79.2% of ruptured aneurysms and 75.2% of unruptured aneurysms, compared with 13.5% in the stenosis or occlusion group. The presence of the arc of Bühler showed the strongest association with aneurysm presence (adjusted odds ratio, 18.40; 95% confidence interval, 8.33-44.20; P < .001), followed by PD arc development grade (adjusted odds ratio, 2.19; 95% confidence interval, 1.19-4.16; P = .014). Aneurysm size did not differ significantly between ruptured and unruptured aneurysms (P = .410).

The arc of Bühler and PD arc development were associated strongly with the presence of aneurysms in patients with CeT stenosis. The lack of correlation between aneurysm size and rupture occurrence supports the current guidelines recommending treatment, irrespective of the aneurysm size. These findings suggest that evaluating collateral pathways may help to identify patients who might benefit from closer monitoring or early intervention.