Overview
Pancreaticoduodenal artery aneurysms (PDAAs) are rare vascular lesions associated with significant risk of rupture, often linked with coeliac artery disease 136. Rupture carries a high mortality rate, emphasizing the need for prompt diagnosis and management 13.Diagnosis
Clinical Presentation: Often presents with abdominal pain; rupture may present with retroperitoneal hematoma 145.
Imaging: Plain radiography may show calcifications; definitive diagnosis via intravenous digital subtraction angiography (IVDSA) 3.
Angiographic Findings: Essential for identifying aneurysms and associated vascular abnormalities like coeliac artery occlusion 14.Management
Preventive Treatment: Considered for unruptured aneurysms; effectiveness varies based on patient age and assumed rupture rates 2.
Surgical Intervention: Standard treatment for definitive repair, especially when angiography identifies critical vascular issues 136.
Endovascular Embolization: Effective for acute cases, particularly post-rupture scenarios, using coils for aneurysm occlusion 46.
Revascularization Procedures: Staged hybrid interventions, including bypass grafts, may be necessary for complex cases with coeliac artery involvement 1.Special Populations
Elderly: Higher risk of complications; preventive treatment thresholds vary significantly with age 2.
Comorbidities: Presence of coeliac artery disease complicates management, often necessitating additional revascularization steps 16.Key Recommendations
Early Angiographic Evaluation: Essential for accurate diagnosis and planning of definitive treatment, particularly in cases with suspected coeliac artery involvement (Evidence: Moderate 16).
Endovascular Embolization for Ruptured Aneurysms: Preferred in acute settings to control bleeding and manage complications (Evidence: Moderate 46).
Surgical Intervention for Unruptured Aneurysms: Recommended when angiography reveals significant vascular abnormalities or high-risk features (Evidence: Moderate 13).
Consider Patient-Specific Factors: Tailor treatment decisions based on patient age and comorbidities, as outcomes can vary significantly (Evidence: Expert opinion 26).References
1 Ghoneim B, Nash C, Akmenkalne L, Cremen S, Canning C, Colgan MP et al.. Staged treatment for pancreaticoduodenal artery aneurysm with coeliac artery revascularisation: Case report and systematic review. Vascular 2024. link
2 Takao H, Nojo T, Ohtomo K. True pancreaticoduodenal artery aneurysms: a decision analysis. European journal of radiology 2010. link
3 Iyomasa S, Matsuzaki Y, Hiei K, Sakaguchi H, Matsunaga H, Yamaguchi Y. Pancreaticoduodenal artery aneurysm: a case report and review of the literature. Journal of vascular surgery 1995. link70111-7)
4 Lossing AG, Grosman H, Mustard RA, Hatswell EM. Emergency embolization of a ruptured aneurysm of the pancreaticoduodenal arcade. Canadian journal of surgery. Journal canadien de chirurgie 1995. link
5 Fujii T, Fujinami S, Takeuchi Y, Shiro T, Kitagawa S, Fukui Y et al.. Retroperitoneal haematoma due to ruptured microaneurysm of the pancreaticoduodenal artery. Journal of gastroenterology and hepatology 1993. link
6 Granke K, Hollier LH, Bowen JC. Pancreaticoduodenal artery aneurysms: changing patterns. Southern medical journal 1990. link