Compressive Pancreaticoduodenal Artery Aneurysm Associated With Celiac Artery Stenosis

Peripancreatic artery aneurysms are a rare condition, representing <2% of all splanchnic artery aneurysms, and have been significantly related to celiac axis stenosis. While they are most often asymptomatic, those aneurysms have a strong tendency to rupture (52% rupture rate at the initial presentation) and, in this case, the outcome is often dramatic. Given that reports of this disease are rare, appropriate guidelines are difficult to formulate and different treatment strategies have been proposed. Endovascular management seems to be efficient in the large majority of most recent reports, but open surgery still remains necessary for complex cases, especially when associated with celiac axis stenosis. We report a new occurrence of a symptomatic compressive aneurysm related to common bile duct compression that we treated using a hybrid procedure. The occurrence of splanchnic artery aneurysms is rare, and these lesions are most commonly localized on the splenic artery. Among them, pancreaticoduodenal artery (PDA) aneurysms remain the rarest entity, representing <2% of all splanchnic artery aneurysms. 1 Etiologies can be varied, but a significant association with celiac axis stenosis (CAS) has been noticed in cases of true PDA aneurysms. 2,3 Although uncommon, awareness and early treatment of these lesions are important considering that even if a large variety of clinical manifestations can be observed, the most frequent presentation is an aneurysmal rupture, with a poor prognosis. Treatment guidelines are difficult to assess because most cases have been published as case reports. There have been a select few literature reviews, but no large randomized studies have been conducted. WereporthereacaseofacompressivePDA aneurysm associated with a CAS and a resulting common bile duct dilatation.