Aorto-hepatic bypass graft for repair of an inferior pancreatico-duodenal artery aneurysm associated with coeliac axis occlusion: A case report. (2016)

• Record Type: Journal Article
• Authors: Hughes, Tom; Chatzizacharias, Nikolaos A.; Richards, James; Harper, Simon
• Is Part Of: International journal of surgery case reports. Volume 28(2016)
• Page Start: 131
• Page End: 134
• Publication Date: 2016
• Subjects: IPDA inferior pancreatico-duodenal artery -- PTFE polytetrafluoroethylene -- ceCT contrast enhanced computerised tomography -- HPB hepato-pancreato-biliary -- MDT multidisciplinary team -- GDA gastroduodenal artery -- SMA superior mesenteric artery -- HA hepatic artery; Case report -- Inferior pancreatico-duodenal artery aneurysm -- Coeliac artery stenosis -- Coeliac artery occlusion; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2016.09.035
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: IPDA aneurysms associated with coeliac axis occlusion are rare. Management includes radiologically guided endovascular approach or surgical repair. Given mortalities of greater than 50% with rupture, intervention is indicated. We present a case of a surgical repair with a supra-coeliac aorto-hepatic bypass. Abstract: Introduction: Inferior pancreatico-duodenal artery (IPDA) aneurysms are very rare and commonly associated with coeliac axis stenosis or occlusion due to atherosclerosis, thrombosis or median arcuate ligament syndrome. We present a case of a surgical repair of an IPDA aneurysm with the use of a supra-coeliac aorto-hepatic bypass with a polytetrafluoroethylene (PTFE) graft, following a failed initial attempt at an endovascular repair. Presentation: A 75 year old female, who was under investigation for night sweats, was referred to our team with an incidental finding of a 19 mm fusiform IPDA aneurysm. Initial attempt at endovascular coiling of the aneurysm was unsuccessful. Elective surgical repair involved excision of the aneurysm and to restore arterial inflow to the hepatic artery, a PTFE bypass graft was used from the supra-coeliac aorta to the hepatic artery. The patient was well 2 months following the procedure with a patent graft shown on contrast enhanced computer tomography (ceCT). Discussion: Management options for IPDA aneurysms include radiologically guided endovascular approach or surgical repair. Given the high mortality of greater than 50% with ruptured aneurysms intervention is indicated in all detected cases. Conclusion: Surgical excision with bypass grafting from the supra-coeliac aorta, as reported by our team, represents a satisfactory management option in patients where interventional approaches have failed or are not appropriate.