Pancreaticoduodenal Artery Aneurysm Secondary to Median Arcuate Ligament Compression with Stentgrafting to Control Blood Flow: A Case Report

Abstract

We report endovascular stentgrafting to treat an inferior pancreaticoduodenal artery aneurysm with significant stenosis of the celiac artery. A 60-year-old man was diagnosed with an inferior pancreaticoduodenal artery aneurysm on abdominal computed tomography performed at another hospital and was referred to our department for further evaluation. An aneurysm (maximal diameter 20 mm) was identified at the origin of the inferior pancreaticoduodenal artery. The celiac artery was significantly stenosed secondary to compression of the median arcuate ligament. The operation was performed via a bilateral brachial artery approach, and a Viabahn VBX stent-graft was placed in the superior mesenteric artery to seal the origin of the inferior pancreaticoduodenal artery, and a microcatheter was inserted from the celiac artery. Interlocking detachable coils were used to isolate and pack the central aneurysm. Finally, a Viabahn VBX stent-graft was placed at the origin of the celiac artery, which was significantly stenosed. Magnetic resonance imaging performed 6 months postoperatively revealed that the stent-graft was patent, there was no blood flow to the aneurysm, and no increase in the diameter of the aneurysm.