Embolization of a Pancreaticoduodenal Pseudoaneurysm Associated With Median Arcuate Ligament Syndrome

BY CIONI ROBERTO, MD; PERRONE ORSOLA, MD; CERVELLI ROSA, MD; AND SCANDIFFIO ROSSELLA, MD

CASE PRESENTATION

A 45-year-old patient with no significant past medical history presented to our institution with acute upper abdominal pain. On the initial presentation, her hemoglobin level was 7.5 g/dL. 

A contrast-enhanced MDCT was executed (Figure 1). In the arterial phase, a 3-mm pseudoaneurysm of the inferior pancreaticoduodenal artery was detected, as well as stenosis at the point where the aorta leads into the celiac artery.

Figure 1
Figure 3
Figure 2
Figure 4

PROCEDURE DESCRIPTION

The patient was transferred to the angiography suite for coil embolization; an emergency angiography was performed confirming the presence of the pseudoaneurysm (Figure 2). Selective arterial embolization through a femoral approach was performed to treat the vascular lesion. The inferior pancreaticoduodenal artery was embolized with a 2- X 20-mm Interlock™-18 Fibered IDC Occlusion System through the superior mesenteric artery. 

Digital subtraction angiography demonstrated incomplete occlusion of the pseudoaneurysm due to a retrograde flow to the celiac axis, by thin and twisting arterial branches (Figure 3). Then, double catheterization of the pseudoaneurysm, from both the cranial access (gastroduodenal artery and superior pancreaticoduodenal artery) and the caudal one (inferior pancreaticoduodenal artery) was performed by using 2.4-F (0.8 mm) torqueable Bern-shape Direxion™ Microcatheter. 

Finally, a coil embolization of all the inflow vessels was achieved using the Interlock™ Fibered IDC Occlusion System.

FOLLOW-UP AND DISCUSSION

Final angiography demonstrated complete devascularization of the pseudoaneurysm (Figure 4). With the agreement of the vascular surgeons it was decided to surgically treat the celiac artery stenosis. The primary objective was to reduce the arterial inflow to the pancreatico-duodenal arch. Thanks to the trackability and flexibility of the torqueable Bern-shape Direxion, we could catheterize these tortuous and small arterial vessels.

Cioni Roberto, MD
Chief of Radiology Department
Interventional Radiologist
AOUP Hospital
Pisa, Italy
Disclosures: None.
Cervelli Rosa, MD
Interventional Radiologist
AOUP Hospital
Pisa, Italy
Disclosures: None.
Perrone Orsola, MD
Interventional Radiologist
AOUP Hospital
Pisa, Italy
Disclosures: None.
Scandiffio Rossella, MD
Interventional Radiologist
AOUP Hospital
Pisa, Italy
Disclosures: None.

Results from case studies are not necessarily predictive of results in other cases. Results in other cases may vary.

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