Celiac Arterial Aneurysms

The American surgeon, 2006

Celiac artery aneurysms (CAA) are uncommon. Most are asymptomatic, but up to 20 per cent will present as surgical emergencies. We present a case of an asymptomatic CAA discovered in a 56-year-old male during evaluation for nephrolithiasis. Only rough estimates of the prevalence of CAA are available, ranging between 0.005 per cent and 0.05 per cent. There appears to be a slight male predominance, and atherosclerotic degeneration is the most common cause. Although most patients are asymptomatic, some will present with vague abdominal pain, nausea, vomiting, or symptoms of mesenteric ischemia. Rupture is a devastating presentation, with reported mortality rates from 35 per cent to 80 per cent. Repair is performed by ligation or reconstruction. Ligation should be considered in an urgent setting, with reconstruction preferred for elective repair. Morbidity and mortality from elective repair should not exceed 5 per cent. Repair of CAA should be undertaken unless major comorbid factors are...

In Vivo

Background/Aim: Celiac artery aneurysms represent rare eventualities which remain symptomatic for a long period of time; however, once diagnosed, it should be carefully monitored due to the high risk of developing lifethreatening complications. When it comes to the types of therapeutic strategies, both endovascular and surgical therapies can be taken in consideration. Case Report: Depending on the patency of the collateral network, simple ligation or graft placement should be performed. The aim of the current paper is to report the case of a patient diagnosed with a celiac trunk aneurysm who was successfully submitted to resection in association with iliac graft placement between the abdominal aorta and the common hepatic artery. Conclusion: Whenever celiac artery aneurysm is diagnosed, it should be closely monitored and treated, resection and reconstruction being a feasible method in order to avoid the development of a life-threatening complication. Celiac artery accounts for up to 30% of all visceral artery aneurysms, the most commonly encountered causes being represented by atherosclerosis or congenital defects, although

Texas Heart Institute Journal, 2017

Celiac artery aneurysms are rare and typically warrant surgical treatment. Atherosclerosis is their chief cause. Symptomatic patients usually present with abdominal pain. Surgical resection of celiac artery aneurysms is associated with low morbidity and mortality rates. We report the case of a patient whose 2.2-cm celiac artery aneurysm we resected, with subsequent saphenous vein bypass grafting from the celiac trunk to the splenic and common hepatic arteries. In addition, we briefly discuss other treatment options.

West African Journal of Radiology, 2013

An 85-year-old male presented with a pain in the right hypochondriac and epigastric region with multiple episodes of hematemesis for about 3 years which had increased in frequency in the last 3 months. There was no history of trauma, fever, altered bowel habits, abdominal or chest infections. Patient is a chronic smoker for last 50 years. His upper gastrointestinal (GI) endoscopy was normal. The cardiovascular system was within normal limits. Ultrasound showed dilated celiac axis with extension to the common hepatic artery. Computed tomographic (CT) angiography reveals aneurysmal dilatation of the celiac trunk extending into the common hepatic artery with thrombosis of a portion of the lumen of the aneurysm, which also shows calcification within. The combined diameter of the aneurysm including the thrombosed portion is approximately 5.5 cm in size. The patent lumen of aneurysm other than thrombosed portion measures approximately 2.2 cm. The splenic artery and left gastric artery arising from the aneurysmally dilated celiac trunk shows mild irregularity, however, no evidence of aneurysmal dilatation of these arteries are noted. The aneurysm extends up to the origin of the gastroduodenal artery, however, hepatic artery proper is not dilated and is noted to divide into the left hepatic artery and right hepatic artery in a normal fashion [ ]. Superior mesenteric artery (SMA) and its branches show adequate opacification.

International Journal of Surgery Case Reports

INTRODUCTION: Celiac artery aneurysm is very rare visceral artery aneurysm. Symptomatic and ≥ 2.5 cm sized aneurysm requires treatment. Excision and revascularization is the most commonly employed procedure. CASE PRESENTATION: We report a case of ligation and excision of celiac artery aneurysm extending onto the splenic and hepatic arteries without vascular reconstruction. The patient was a 52 year old lady who was evaluated for abdominal pain and was found to have a celiac artery aneurysm involving the hepatic and splenic arteries. She was evaluated with computerized tomography and digital subtraction angiography of the abdominal vessels. These confirmed good natural collaterals from the branches of superior mesenteric artery supplying the liver, stomach and spleen. We performed ligation and excision of the aneurysm and ligation and division of hepatic, splenic and left gastric arteries as the aneurysm was extending on to these vessels, without any vascular reconstruction, utilizing the natural collaterals from the superior mesenteric artery. DISCUSSION: Ligation of celiac artery aneurysm without revascularization is often done in emergency situations. Excision and revascularization is the treatment of choice to ensure adequate blood supply to liver, spleen and stomach. We could utilize the natural collateral circulation of celiac artery from superior mesenteric artery avoiding a complex procedure of revascularization. CONCLUSION: We present this because of the rarity of the disease as well as rarity of the technique of not performing vascular reconstruction. We emphasize on the pre-operative and operative evaluation of collateral circulation with conventional angiography and intraoperative Doppler respectively.

Radiology Case Reports, 2019

Visceral artery aneurysms are very rare and aneurysms of the celiac trunk are the rarest ones: they are in most cases asymptomatic and their detection is frequently incidental. In this article we report the case of a man affected by severe abdominal pain with a huge aneurysm of the celiac trunk, first successfully treated with coil embolization, but, after 10 months, another endovascular embolization was required for deployment of the metallic coils previously released, ahead into the fund of the sac with recanalization of the aneurysm. A second endovascular treatment was performed with other coils and Amplatzer-Plug. The high risk of rupture makes treatment of such aneurysms mandatory and surgery is still considered the gold standard therapy of VAA, but, due to its high morbidity and mortality risks, in the last years, it has been widely replaced by endovascular embolization. An effective endovascular embolization requires not only the complete filling of the aneurysmal sac, but also the complete vascular exclusion of its inflow and out-flow tracts, to reduce the risk of its anterograde or retrograde reperfusion.

Journal of Vascular Surgery, 2013

Objective: To report the safe and effective treatment of celiac axis aneurysm (CAA) using a covered stent plus coil embolization of the gastric and splenic arteries, and to assess the results of similar cases treated using endovascular techniques. Methods: Case report and PUBMED literature review (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013) of cases treated using endovascular techniques. Results: Successful exclusion of an enlarging CAA was performed using a covered stent placed from the origin of the axis into the common hepatic artery via a brachial approach; concomitantly, the splenic and gastric arteries were embolized. A PUBMED literature review revealed the successful endovascular treatment of CAA in 25. Stent graft exclusion was described a total of seven times: three within the axis itself, three landing in the splenic artery, and one landing in the hepatic artery. Conclusions: Various methods of endovascular treatment of CAA have been reported to be safe and effective. Depending upon anatomy, this report suggests that preservation of blood flow to the hepatic artery with coil embolization of the gastric and splenic arteries is effective in treating this condition while maintaining important foregut blood flow.

International Journal of Vascular Surgery and Medicine

In a patient with a known history of aortic surgery, presence of upper gastrointestinal bleeding requires a high index suspicion for the possibility of aorto-enteric fistula. Aorto-enteric fistula is an uncommon but known complication occurring after abdominal aortic reconstruction. However, there are few reported cases of enteric fistulas arising after splanchnic artery aneurysm repair. We report a unique case of a celiac artery graft-duodenal fistula in a 60-year-old male, who developed upper gastrointestinal bleeding two months after initial open resection of a celiac artery aneurysm and placement of an aorto-celiac artery graft. The patient underwent successful repair of the fistula and the resection of the involved graft with ligation of the common hepatic artery and splenectomy. Our case report highlights the rare entity of celiac arterio-enteric fistula after open repair of a celiac artery aneurysm and reviews the diagnostic and treatment modalities available for successful management of this rare complication. "splanchnic artery aneurysm fistula", "celiac artery aneurysm fistula", "celiac artery aneurysm" and "aortoenteric fistula" revealed no case reports describing secondary arterioenteric fistulas arising after open celiac artery aneurysm repair. The extremely low incidence of celiac artery aneurysm and similarly low incidence of secondary fistula after repair of aneurysms may account for the paucity of literature on this topic. We describe a unique case of a secondary celiac arterioenteric fistula below. Case Presentation A 60 year old male underwent open resection of celiac artery aneurysm with placement of prosthetic graft between the aorta and the junction of common hepatic artery and splenic artery (Figures 1a,1b). Two months after the surgery, the patient presented to our institution with 2 week history of abdominal pain, fever, and unintentional weight loss. His past medical and surgical history was significant for stent placement for bilateral common iliac artery aneurysms. Computed tomography of the abdomen revealed a fluid collection with gas bubbles in the lesser sac adjacent to the graft site raising suspicion for graft infection (Figures 2a,2b,2c). Within twelve hours of admission, the patient developed two episodes of hematemesis. The patient remained hemodynamically stable. Physical exam revealed no peritoneal signs. The patient's hemoglobin and hematocrit were stable at 9.4 g/dL and 29.6% respectively. The patient was emergently taken to the operating room. Intra operatively, a selective celiac artery angiogram was performed and showed a ring like stenosis at the distal graft anastomosis. There was no contrast extravasation noted. Intraabdominal exploration revealed two discrete foul-smelling fluid collections containing fresh blood in the lesser sac. Further evaluation

Case reports in vascular medicine, 2015

We report on an asymptomatic 56-year-old male with incidental diagnosis of celiac trunk aneurysm, diagnosed during an ultrasound scan performed to control polycystic kidney disease. The CT scan revealed a 3.8 cm saccular aneurysm of the celiac artery dissected in the superior wall with a consequent 4.3 cm pseudoaneurysm; we adopted an endovascular approach to exclude the lesion by catheterizing the celiac trunk and positioning a vascular plug in the common hepatic artery and a covered stent in the splenic artery; finally we fulfilled the aneurysm sac with Onyx. 30-day control CT scan revealed procedural success. Five years later he came back to our department for an aneurysm relapse in the common hepatic artery. We performed a second endovascular approach with a superselective catheterization of the pancreaticoduodenal arcade in order to exclude the lesion with Onyx and microcoils. Nowadays the patient is in good clinical conditions. Endovascular approach is a valuable method to tre...

CardioVascular and Interventional Radiology, 2010

Celiac trunk aneurysms are rare and usually asymptomatic lesions. However, treatment is generally warranted to avoid catastrophic rupture. We report a case of a 70-year-old man who sought care for a celiac trunk aneurysm close to the hepatosplenic bifurcation managed endovascularly by using a combined treatment of celiac-splenic stent-graft implantation and hepatic artery embolization.