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Aneurysms of Peripancreatic Arterial Arcades Coexisting with Celiac Trunk Stenosis or Occlusion: Single Institution Experience.

Abstract Introduction. True aneurysms of peripancreatic arterial arcades (PAAAs) are rare. Most of them coexist with celiac axis stenosis/occlusion due to median arcuate ligament (MAL) compression or atherosclerosis. The aim of this study was to evaluate the cause of celiac axis lesion and characterize the anatomy of the aneurysms. These findings may have important management implications. Material and Methods. A retrospective analysis of 15 patients with true PAAAs was performed. The diagnosis was established by contrast-enhanced CT, using a 64-MDCT scanner. We evaluated the most probable cause of celiac axis lesion. Aneurysms were characterized by their number, location, size, and morphology. Location of the aneurysms was classified either as pancreaticoduodenal arteries (PDA) or as dorsal pancreatic arteries (DPA) as they may represent different collateral pathways between superior mesenteric artery and celiac trunk. Results. A total of 32 true PAAAs were identified. Celiac trunk was occluded in 12 patients and critically narrowed in 3 patients. Celiac axis lesion was categorized as secondary to MAL compression in 14 cases and due to atherosclerosis in 1 case. The most common location of the aneurysms was inferior pancreaticoduodenal arteries. Only in 1 case aneurysms involved both PDA and DPA. Conclusions. Coexistence of PAAAs with celiac axis compression as well as involvement of either PDAs or DPAs has important therapeutic implications. The uninvolved collateral pathway may be sufficient to preserve effective circulation in celiac trunk branches in case of resection or embolization of the aneurysms. However, further studies are crucial to confirm our findings.
PMID
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Authors

Mayor MeshTerms

Aneurysm

Celiac Artery

Computed Tomography Angiography

Pancreas

Keywords
Journal Title biomed research international
Publication Year Start




PMID- 28286755
OWN - NLM
STAT- MEDLINE
DA  - 20170313
DCOM- 20170317
LR  - 20170317
IS  - 2314-6141 (Electronic)
VI  - 2017
DP  - 2017
TI  - Aneurysms of Peripancreatic Arterial Arcades Coexisting with Celiac Trunk
      Stenosis or Occlusion: Single Institution Experience.
PG  - 1645013
LID - 10.1155/2017/1645013 [doi]
AB  - Introduction. True aneurysms of peripancreatic arterial arcades (PAAAs) are rare.
      Most of them coexist with celiac axis stenosis/occlusion due to median arcuate
      ligament (MAL) compression or atherosclerosis. The aim of this study was to
      evaluate the cause of celiac axis lesion and characterize the anatomy of the
      aneurysms. These findings may have important management implications. Material
      and Methods. A retrospective analysis of 15 patients with true PAAAs was
      performed. The diagnosis was established by contrast-enhanced CT, using a 64-MDCT
      scanner. We evaluated the most probable cause of celiac axis lesion. Aneurysms
      were characterized by their number, location, size, and morphology. Location of
      the aneurysms was classified either as pancreaticoduodenal arteries (PDA) or as
      dorsal pancreatic arteries (DPA) as they may represent different collateral
      pathways between superior mesenteric artery and celiac trunk. Results. A total of
      32 true PAAAs were identified. Celiac trunk was occluded in 12 patients and
      critically narrowed in 3 patients. Celiac axis lesion was categorized as
      secondary to MAL compression in 14 cases and due to atherosclerosis in 1 case.
      The most common location of the aneurysms was inferior pancreaticoduodenal
      arteries. Only in 1 case aneurysms involved both PDA and DPA. Conclusions.
      Coexistence of PAAAs with celiac axis compression as well as involvement of
      either PDAs or DPAs has important therapeutic implications. The uninvolved
      collateral pathway may be sufficient to preserve effective circulation in celiac 
      trunk branches in case of resection or embolization of the aneurysms. However,
      further studies are crucial to confirm our findings.
FAU - Antoniak, Robert
AU  - Antoniak R
AD  - 2nd Department of Radiology, Medical University of Warsaw, Banacha 1a St., 02-097
      Warsaw, Poland.
FAU - Grabowska-Derlatka, Laretta
AU  - Grabowska-Derlatka L
AUID- ORCID: 0000-0002-6511-6579
AD  - 2nd Department of Radiology, Medical University of Warsaw, Banacha 1a St., 02-097
      Warsaw, Poland.
FAU - Nawrot, Ireneusz
AU  - Nawrot I
AUID- ORCID: 0000-0002-4407-8614
AD  - Department of General, Vascular, and Transplantation Surgery, Medical University 
      of Warsaw, Banacha 1a St., 02-097 Warsaw, Poland.
FAU - Cieszanowski, Andrzej
AU  - Cieszanowski A
AD  - 2nd Department of Radiology, Medical University of Warsaw, Banacha 1a St., 02-097
      Warsaw, Poland.
FAU - Rowinski, Olgierd
AU  - Rowinski O
AD  - 2nd Department of Radiology, Medical University of Warsaw, Banacha 1a St., 02-097
      Warsaw, Poland.
LA  - eng
PT  - Journal Article
DEP - 20170213
PL  - United States
TA  - Biomed Res Int
JT  - BioMed research international
JID - 101600173
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - *Aneurysm/diagnostic imaging/pathology/physiopathology
MH  - *Celiac Artery/diagnostic imaging/pathology/physiopathology
MH  - *Computed Tomography Angiography
MH  - Constriction, Pathologic/diagnostic imaging/pathology/physiopathology
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Pancreas/blood supply/diagnostic imaging/pathology/physiopathology
MH  - Retrospective Studies
PMC - PMC5327782
COI - The authors declare that they have no competing interests.
EDAT- 2017/03/14 06:00
MHDA- 2017/03/18 06:00
CRDT- 2017/03/14 06:00
PHST- 2016/11/08 [received]
PHST- 2017/01/04 [revised]
PHST- 2017/01/23 [accepted]
AID - 10.1155/2017/1645013 [doi]
PST - ppublish
SO  - Biomed Res Int. 2017;2017:1645013. doi: 10.1155/2017/1645013. Epub 2017 Feb 13.

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