Pancreaticoduodenal Artery Aneurysm Complicated by Median Arcuate Ligament Syndrome.

Abstract

PURPOSE:

To highlight median arcuate ligament syndrome as a potential cause for celiac artery stenosis and pancreaticoduodenal artery aneurysm, and describe treatment options in this setting.

CASE REPORT:

A 63-year-old male presented with a pancreaticoduodenal artery aneurysm and concomitant celiac artery stenosis that was treated with celiac artery stenting and aneurysm coiling. He subsequently developed stent fracture and celiac artery occlusion secondary to previously unrecognized median arcuate ligament syndrome causing reperfusion of the aneurysm. This was treated with open median arcuate ligament release and aorta to common hepatic artery bypass with good clinical result and stable 20-month surveillance imaging.

CONCLUSION:

It is critical to recognize median arcuate ligament syndrome as a cause of celiac artery stenosis in the setting of pancreaticoduodenal artery aneurysm given the high risk of failure of endovascular stenting. Open aorto-hepatic artery bypass and endovascular aneurysm coiling should be the preferred approach in these patients.

• Authors: Sean Hamlin, Stephen R Gallo, Jameson Petrochko, Jacob Wilson, Sharvil Sheth
• Journal: Vascular and endovascular surgery (Vasc Endovascular Surg) Vol. 58 Issue 2 Pg. 213-217 (Feb 2024) ISSN: 1938-9116 [Electronic] United States
• PMID: 37635365 (Publication Type: Case Reports, Journal Article)

Topics

• Male
• Humans
• Middle Aged
• Median Arcuate Ligament Syndrome (complications, diagnostic imaging, surgery)
• Constriction, Pathologic (complications, surgery)
• Aortic Aneurysm, Abdominal (surgery)
• Pancreas (diagnostic imaging, blood supply)
• Embolization, Therapeutic (methods)
• Endovascular Procedures
• Blood Vessel Prosthesis Implantation
• Treatment Outcome
• Celiac Artery (diagnostic imaging, surgery)