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. 2023 Jul 14;12(14):4692.
doi: 10.3390/jcm12144692.

Interventional Radiology for High-Flow Aneurysm of the Pancreaticoduodenal Arcades with Median Arcuate Ligament Syndrome: Review of 14 Patients

Valentin Siauve  1 , Olivier Chevallier  1   2 , Amin Mazit  1 , Nicolas Falvo  1   2 , Pierre-Olivier Comby  2   3 , Romaric Loffroy  1   2
Affiliations

Interventional Radiology for High-Flow Aneurysm of the Pancreaticoduodenal Arcades with Median Arcuate Ligament Syndrome: Review of 14 Patients

Valentin Siauve et al. J Clin Med. .

Abstract

Transarterial embolization (TAE) for high-flow pancreaticoduodenal artery (PDA) aneurysms in patients with celiac-trunk stenosis by the median arcuate ligament (MAL) has been found effective both after rupturing and to prevent rupture. The objective was to describe the TAE techniques used and their effectiveness in excluding PDA aneurysms due to MAL syndrome. This single-center retrospective study done at the Dijon-Bourgogne University Hospital included all patients treated by TAE in 2010-2022 for ruptured or unruptured high-flow PDA aneurysms caused by MAL syndrome. We identified 14 patients (7 women and 7 men; mean age, 64 years). Packing and trapping techniques were used alone or together. Occlusion was with microcoils, co-polymer, or cyanoacrylate glue, used separately or combined. Technical success was achieved in 13 (93%) patients. Clinical success was achieved in 12 (86%) patients. One major and two minor complications were recorded within the first 30 days. No complications occurred after 30 days. Follow-up ranged from 1 to 84 months. No cases of aneurysm recanalization have been recorded to date. TAE had high technical and clinical success rates in our patients with unruptured or ruptured PDA aneurysms due to MAL syndrome.

Keywords: celiac trunk; high-flow aneurysm; interventional radiology; median arcuate ligament; pancreaticoduodenal artery; transcatheter arterial embolization.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Computed tomography in a sagittal reconstruction (A) and with volume rendering (B) showing stenosis of the celiac-trunk ostium due to compression by the median arcuate ligament (solid arrow) and an aneurysm of the pancreaticoduodenal artery (dotted arrow).
Figure 2
Figure 2
Patient with an unruptured pancreaticoduodenal artery aneurysm: (A) Computed tomography in a coronal view with maximum-intensity-projection reformatting showing the aneurysm (arrowhead: superior mesenteric artery; dotted arrow: afferent branch; solid arrow: efferent branch); (B) superior mesenteric artery angiogram in the same patient (same annotation).
Figure 3
Figure 3
Angiogram of the superior mesenteric artery during transarterial embolization by combined packing and trapping techniques: (A) Screening angiogram before treatment (arrowhead: catheter within the superior mesenteric artery ostium; dotted arrow: afferent branch; solid arrow: efferent branch); (B) Final angiogram after treatment showing absence of flow into, and downstream of, the efferent branch (solid arrow) compared to the initial angiogram.
See this image and copyright information in PMC

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