Management Of Pancreaticoduodenal Aneurysms Based On A Single Institution Experience
Kunal Vani, DO, Keith Calligaro, MD, Krystal Maloni, MD, Nicholas Madden, DO, Douglas Troutman, DO, Matthew Dougherty, MD.
Pennsylvania Hospital, Philadelphia, PA, USA.
OBJECTIVES: Pancreaticoduodenal aneurysms (PDAs) are rare and have a high propensity for rupture. Approximately 160 cases have been reported. Historically, management of PDAs included surgical reconstruction but has evolved with advances in endovascular therapy. We report our experience with management of PDAs during the last thirty years.
METHODS: We retrospectively reviewed our prospectively maintained registry between January 1, 1992 - March 30, 2020. RESULTS: We identified seven patients with PDAs: three with associated celiac artery occlusive disease and four without identifiable etiologies. Four patients were treated with surgical resection of the PDAs: two intact aneurysms underwent concomitant revascularization (superior mesenteric artery-to-hepatic artery Dacron bypass; supra celiac aorta-to-hepatic artery Dacron bypass) and two (1 intact, 1 rupture) underwent ligation alone. Three patients were treated with coil embolization of the PDA: two with concomitant stent-graft exclusion of the aneurysm (1 non-rupture, 1 rupture) and one without adjunctive measures (intact). There were no deaths nor any significant procedure-related morbidity. CONCLUSIONS: Our large single-center experience shows that PDAs can be successfully treated by open or endovascular intervention with selective revascularization.
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