A Surgical Resection of Pancreaticoduodenal Artery Aneurysm Which Required an Aorto-hepatic Artery Bypass Grafting

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  • 総肝動脈再建を要した膵十二指腸動脈瘤の一手術例

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<p>Pancreaticoduodenal artery is a branch of superior mesenteric artery (SMA). Although pancreaticoduodenal artery aneurysm (PDAA) is a rare disease, treatment is required because of the risk of rupture. A 46-year-old man has visited other hospital for type1 diabetes. He had a PDAA with a maximum minor-axis diameter of 20 mm pointed out by abdominal contract-enhanced computed tomography (CECT) and was admitted to our hospital. Preoperative CECT and angiography demonstrated severe stenosis of the celiac artery (CA) and the common hepatic artery (CHA) and the splenic artery were supplied through the PDA from SMA by collateral circulations. An open surgical repair was selected because of anatomical limitations of the aneurysm. The CA had difficulty of repair since the artery was atrophied, and the clamp test of PDA indicated beat attenuation of the CHA, resulting that we performed an abdominal aorta-CHA bypass followed by aneurysmectomy. PDAA is often caused by the development of collateral circulation route with CA stenosis. The treatment strategy of PDAA depends on several anatomical factors including relationship between aneurysm and SMA trunk, suitability of endovascular treatment in addition to involvement of CA stenosis.</p>

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