Embolization of a pancreatico-duodenal pseudoaneurysm associated with Median Arcuate Ligament Syndrome

Baseline Central

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

In the arterial phase a 3mm pseudoaneurysm of the inferior pancreatico-duodenal artery was detected, as well as stenosis at the point where the aorta leads into celiac artery.

First Treatment

The patient was transferred to the angiography suite for coil embolization; an emergency angiography was performed confirming the presence of the pseudoaneurysm.

Selective arterial embolization through a femoral approach was performed to treat the vascular lesion.

The inferior pancreatico-duodenal artery was embolized with a 2x20 mm coils through the superior mesenteric artery.

Second Treatment

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

Finally, a coil embolization of all the inflow vessels was obtained.


The angiography check demonstrated the complete devascularization of the pseudoaneurysm. 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, a catheterization of tortuos and small arterial vessel was permitted.

Study and images courtesy of
Dr. Cioni Roberto - Chief of Radiology Department & Interventional Radiologist - "AOUP Hospital" - Pisa
Dr. Perrone OrsolaDr. Cervelli RosaDr. Scandiffio Rossella - Interventional Radiologists - "AOUP Hospital" - Pisa