PDF(Pubmed)
Abstract：
BACKGROUND: Pancreaticoduodenal artery aneurysm (PDAA) is a rare, but fatal disease. However, the association between aneurysm size and the risk of rupture remains unclear. There are many options for therapeutic strategies that should be discussed well because the treatment options are often complicated and highly invasive. However, it remains unclear whether additional endovascular therapy is essential for all patients undergoing bypass surgery. Here, we present a case of triple PDAAs with celiac axis occlusion and spontaneous complete regression of inferior PDAAs (IPDAA) after aneurysmectomy of superior PDAA (SPDAA) and aorto-splenic bypass.
METHODS: A 68-year-old woman presented with one SPDAA and two IPDAAs caused by celiac axis occlusion. Aneurysmectomy for IPDAAs was difficult because of their anatomical location and shape. Therefore, we planned a two-stage hybrid therapy. The patient underwent aorto-splenic bypass and resection of the SPDAA. Follow-up CT was performed to evaluate the IPDAAs before planned endovascular embolization. Spontaneous regression of the IPDAAs and normalized PDA arcade decreased the blood flow in the PDA arcade. The patient is doing well without graft occlusion, and the IPDAAs have completely regressed 7 years after surgery.
CONCLUSIONS: Normalization of hyperinflow to the PDA arcade can lead to the regression of PDAA. Potentially, additional endovascular therapy may not be required in all cases when dilation of the PDA improves. However, more cases must be accumulated to establish criteria for predicting the risks of short- and long-term PDAA ruptures.
METHODS: A 68-year-old woman presented with one SPDAA and two IPDAAs caused by celiac axis occlusion. Aneurysmectomy for IPDAAs was difficult because of their anatomical location and shape. Therefore, we planned a two-stage hybrid therapy. The patient underwent aorto-splenic bypass and resection of the SPDAA. Follow-up CT was performed to evaluate the IPDAAs before planned endovascular embolization. Spontaneous regression of the IPDAAs and normalized PDA arcade decreased the blood flow in the PDA arcade. The patient is doing well without graft occlusion, and the IPDAAs have completely regressed 7 years after surgery.
CONCLUSIONS: Normalization of hyperinflow to the PDA arcade can lead to the regression of PDAA. Potentially, additional endovascular therapy may not be required in all cases when dilation of the PDA improves. However, more cases must be accumulated to establish criteria for predicting the risks of short- and long-term PDAA ruptures.
摘要：
背景：胰十二指肠动脉瘤（PDAA）是一种罕见的，而是致命的疾病.然而,动脉瘤大小与破裂风险之间的关联尚不清楚.有许多治疗策略的选择应该很好地讨论，因为治疗选择通常是复杂且高侵入性的。然而,目前尚不清楚是否所有接受搭桥手术的患者都需要额外的血管内治疗.这里,我们介绍了一例上PDAA（SPDAA）动脉瘤切除术和主动脉脾旁路后，三联PDAA伴有腹腔轴闭塞和下PDAA（IPDAA）自发完全消退的病例。
方法：一名68岁女性因腹腔轴闭塞而出现1例SPDAA和2例IPDAA。IPDAA的动脉瘤切除术由于其解剖位置和形状而很困难。因此,我们计划了两阶段混合疗法.患者接受了主动脉脾旁路术和SPDAA切除术。在计划的血管内栓塞之前，进行随访CT以评估IPDAA。IPDAA的自发消退和标准化的PDA拱廊降低了PDA拱廊中的血流量。病人在没有移植物阻塞的情况下做得很好，IPDAA在手术后7年完全消退。
结论：PDA拱廊的高流入标准化可导致PDAA的消退。有可能,当PDA的扩张改善时,可能并非在所有病例中都需要额外的血管内治疗.然而,必须积累更多病例,以建立预测短期和长期PDAA破裂风险的标准.
方法：一名68岁女性因腹腔轴闭塞而出现1例SPDAA和2例IPDAA。IPDAA的动脉瘤切除术由于其解剖位置和形状而很困难。因此,我们计划了两阶段混合疗法.患者接受了主动脉脾旁路术和SPDAA切除术。在计划的血管内栓塞之前，进行随访CT以评估IPDAA。IPDAA的自发消退和标准化的PDA拱廊降低了PDA拱廊中的血流量。病人在没有移植物阻塞的情况下做得很好，IPDAA在手术后7年完全消退。
结论：PDA拱廊的高流入标准化可导致PDAA的消退。有可能,当PDA的扩张改善时,可能并非在所有病例中都需要额外的血管内治疗.然而,必须积累更多病例,以建立预测短期和长期PDAA破裂风险的标准.
