Hemodynamic benefits of celiac artery release for ruptured right gastric artery aneurysm associated with median arcuate ligament syndrome: a case report
Open Access
- 28 November 2017
- journal article
- case report
- Published by Springer Science and Business Media LLC in BMC Surgery
- Vol. 17 (1), 116
- https://doi.org/10.1186/s12893-017-0320-0
Abstract
It has been reported that median arcuate ligament syndrome is closely associated with gastric or pancreaticoduodenal artery aneurysms. Hemodynamic state plays an important role in the formation of the aneurysms. These aneurysms are treated with open resection or endovascular exclusion. However, whether revascularization of the celiac artery can prevent the aneurysm formation is unknown. This report indicated a possibility that prophylactic revascularization for celiac artery stenosis resulted in decreased shear stress on the collaterals, which may otherwise be susceptible to new aneurysms. This report describes a 51-year-old man who presented with epigastric pain at our hospital. According to contrast enhanced computed tomography (CT), he was diagnosed with a ruptured right gastric artery aneurysm and celiac artery stenosis caused by the median arcuate ligament (MAL). He had a vascular anomaly of the common hepatic artery arising from the superior mesenteric artery (SMA). His vital signs were stable. We informed him of the situation and he chose open surgery rather than endovascular treatment. Following, we resected the aneurysm and transected the MAL. Intraoperative angiography after transection of the MAL showed the antegrade blood flow to the splenic artery instead of the retrograde flow via the prominent collaterals. Follow-up CT confirmed narrowed collateral vessels between the SMA and the celiac artery without de-novo aneurysms. While the necessity of celiac artery release could be questioned, the present case supports the hemodynamic benefits of MAL transection in terms of de-novo aneurysm prevention.This publication has 13 references indexed in Scilit:
- Does Management of True Aneurysms of Peripancreatic Arteries Require Repair of Associated Celiac Artery Stenosis?Journal of the American College of Surgeons, 2016
- Ruptured Left Gastric Artery Aneurysms: Three Cases Managed Successfully with Open Surgical RepairAnnals of Vascular Surgery, 2016
- Gender Predicts Rupture of Pancreaticoduodenal Artery AneurysmsAnnals of Vascular Surgery, 2016
- Pancreaticoduodenal Artery Aneurysms Secondary to Median Arcuate Ligament Syndrome May Not Need Celiac Artery Revascularization or Ligament ReleaseAnnals of Vascular Surgery, 2015
- Pancreatoduodenal artery aneurysm resulting from median arcuate ligament compression successfully treated with laparoscopic ligament sectionAsian Journal of Endoscopic Surgery, 2014
- Two Patients with Ruptured Posterior Inferior Pancreaticoduodenal Artery Aneurysms Associated with Compression of the Celiac Axis by the Median Arcuate LigamentAnnals of Vascular Diseases, 2014
- Treatment Strategies for a Pancreaticoduodenal Artery Aneurysm with or without a Celiac Trunk Occlusive LesionAnnals of Vascular Diseases, 2013
- ‘All That Glitters isn't Gold’: Rupture of an Undiagnosed Splanchnic Aneurysm in the Presence of an Aortic AneurysmEuropean Journal of Vascular and Endovascular Surgery, 2005
- Current management of visceral artery aneurysmsSurgery, 1996
- A RARE OBSTRUCTION OF THE COELIAC ARTERY. REPORT OF A CASE.1963