Skip to main content
Log in

A Ruptured Pancreaticoduodenal Artery Aneurysm Repaired by Combined Endovascular and Open Techniques

  • Case Reports
  • Published:
Annals of Vascular Surgery


Aneurysms of the pancreaticoduodenal arteries (PDA) are rare, accounting for <2% of all visceral aneurysms. An association with celiac artery stenosis has been reported. Many present with rupture, and a high mortality can be expected. Treatment is therefore challenging. Arterial ligation, anuerysmectomy, or bypass has been the mainstay of treatment. We recently treated a patient (who had no celiac axis) with a ruptured PDA aneurysm with combined open and endovascular techniques. A 46-year-old man was transferred to our hospital with a 1-day history of abdominal pain and syncope. On admission, an abdominal and pelvis computerized tomographic (CT) scan identified a large mesenteric hematoma, a 1.9 cm PDA aneurysm, and an occluded celiac axis. Mesenteric angiography revealed no active aneurysm leak and a stenotic superior mesenteric artery (SMA) origin. All hepatic blood flow originated from the stenotic SMA via markedly enlarged PDA collaterals. The patient was brought to the operating room, where absence of the celiac axis was confirmed. An aorto-to-proper hepatic and SMA bypass was performed using a bifurcated polyester graft. The next day, the patient was brought to the angiography suite, where the PDA aneurysm was coiled. Postprocedure CT scans confirmed thrombosis of the aneurysm. Ruptured mesenteric artery aneurysms are a challenging problem for the vascular surgeon. PDA aneurysms are rare and often occur in an unfavorable location. There appears to be an association with anatomic anomalies of the mesenteric circulation. Prompt invasive and noninvasive diagnostic studies aid in the definitive management of this often fatal problem. Combined endovascular and open techniques can be used for successful treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1.
Fig. 2.
Fig. 3.
Fig. 4.
Fig. 5.

Similar content being viewed by others


  1. Stanley JC, Wakefied TW, Graham LM, et al. Clinical importance and management of splanchnic artery aneurysms. J Vasc Surg 1986;3:836-840

    Article  PubMed  CAS  Google Scholar 

  2. De Perrot M, Berney T, Deleaval J, et al. Management of the true aneurysms of the pancreaticoduodenal arteries. Ann Surg 1999;229:416-420

    Article  PubMed  Google Scholar 

  3. Iyomasa S, Matsuzaki Y, Hiei K, et al. Pancreaticoduodenal artery aneurysm: a case report and review of the literature. J Vasc Surg 1995;22:161-166

    Article  PubMed  CAS  Google Scholar 

  4. Sutton D, Lawton G. Coeliac stenosis or occlusion with aneurysm of the collateral supply. Clin Radiol 1973;24:49-53

    Article  PubMed  CAS  Google Scholar 

  5. Kobayashi T, Uenoyama S, Isogai S. Successful transcatheter arterial embolization of an inferior pancreaticoduodenal artery aneurysm associated with celiac axis stenosis. J Gastroenterol Hepatol 2004;19:599-601

    Article  PubMed  Google Scholar 

  6. Peterson BG, Resnick SA, Eskandari MK. Coil embolization of an inferior pancreaticoduodenal artery aneurysm associated with celiac artery occlusion. Cardiovasc Surg 2003;11:515-519

    Article  PubMed  Google Scholar 

  7. Ogino H, Sato Y, Banno T, et al. Embolization in a patient with ruptured anterior inferior pancreaticoduodenal arterial aneurysm with median arcuate ligament syndrome. Cardiovasc Intervent Radiol 2002;25:318-319

    Article  PubMed  Google Scholar 

  8. Ducasse E, Roy F, Chevalier J, et al. Aneurysm of the pancreaticoduodenal arteries with a celiac trunk lesion: current management. J Vasc Surg 2004;39:906-911

    Article  PubMed  CAS  Google Scholar 

  9. Iyori K, Horigome M, Yumoto S, et al. Aneurysm of the gastroduodenal artery associated with absence of the celiac axis: report of a case. Surg Today 2004;34:360-362

    Article  PubMed  Google Scholar 

  10. Moore E, Matthews MR, Minion DJ, et al. Surgical management of peripancreatic arterial aneurysms. J Vasc Surg 2004;40:247-253

    Article  PubMed  Google Scholar 

  11. Gabelmann A, Gorich J, Merkle EM. Endovascular treatment of visceral artery aneurysms. J Endovasc Ther 2002;9:38-47

    Article  PubMed  Google Scholar 

  12. Tarazov PG, Ignashov AM, Pavlovskij AV, et al. Pancreaticoduodenal artery aneurysm associated with celiac axis stenosis combined angiographic and surgical treatment. Dig Dis Sci 2001;46:1232-1235

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Larry W. Kraiss MD.

About this article

Cite this article

Teng, W., Sarfati, M.R., Mueller, M.T. et al. A Ruptured Pancreaticoduodenal Artery Aneurysm Repaired by Combined Endovascular and Open Techniques. Ann Vasc Surg 20, 792–795 (2006).

Download citation

  • Published:

  • Issue Date:

  • DOI: