Endovascular Treatment of a Pancreaticoduodenal Artery Aneurysm in the Context of Celiac Trunk Occlusion.

Abstract

Pancreaticoduodenal artery aneurysms (PDAAs) are rare but potentially life-threatening due to the risk of rupture. Their management is particularly challenging in cases of tortuosity of the parent artery and concurrent celiac trunk occlusion, where collateral circulation must be preserved. We report the case of an 81-year-old female with an 18-mm aneurysm in the pancreaticoduodenal artery, discovered incidentally during a routine liver ultrasound in hepatitis C follow-up. The patient was highly concerned about the risk of rupture but declined open surgical repair. Imaging confirmed celiac trunk occlusion with collateral perfusion via the superior mesenteric artery (SMA). Due to the vascular anatomy, direct catheterization was challenging. A steerable sheath was used to access the parent artery, allowing the deployment of a flow diverter stent to preserve blood flow in the parent artery while coiling the aneurysm in jailing technique. Post-procedural imaging confirmed successful aneurysm occlusion with preserved collateral circulation. The patient was discharged in good condition after 48 hours. This case highlights the technical considerations and alternative endovascular strategies required for managing PDAAs in the presence of tortuosity of the parent artery and celiac trunk occlusion. A combination of flow diversion and coil embolization was effective in aneurysm occlusion while maintaining collateral circulation and preventing rupture.