Abstract
Pancreaticoduodenal artery aneurysm (PDAA) is a rare visceral aneurysm. Since the rupture risk of PDAA is reportedly unrelated to aneurysmal diameter, early diagnosis and appropriate therapeutic intervention are required. Aneurysmal dilatation is related to mechanical stress due to increased flow through the pancreaticoduodenal arcade caused by celiac axis stenosis or occlusion. Tran-scatheter arterial embolization (TAE) is the first line treatment for PDAA. However, TAE itself leads to organ ischemia in the celiac region in some cases. We report four cases of PDAA treated by surgical revascularization and catheter intervention. Hybrid treatment was performed by surgical bypass grafting for the common hepatic artery (CHA) and TAE for the aneurysm in cases 1 and 2. Postoperative CT showed no enhancement of the aneurysm and sufficient collateral blood supply via the patent bypass graft. Aneurysm resection was performed with bypass grafting for the CHA in case 3, with artery reconstruction in case 4. Small-diameter aneurysms were left untouched in cases 3 and 4 due to anatomical reasons. In case 3, however, which was able to reduce mechanical stress, the residual aneurysm decreased in size. In case 4, on the other hand, persistence of mechanical stress led to an increase in size of the residual aneurysm. This suggests that the presence of mechanical stress in the pancreaticoduodenal arcade might affect the change in the residual aneurysm diameter, and hence, it is necessary to determine the operative method in each case considering the patient background factors and surgical invasiveness.
