Embolization of ruptured pancreaticoduodenal arcade aneurysms due to median arcuate ligament without celiac artery revascularization: a single-center experience and literature review.

Abstract

Background: The aim of this single-center retrospective study is to evaluate the feasibility, complications, and outcomes of transarterial embolization (TAE) for ruptured pancreaticoduodenal arcades aneurysms (PDAAs) due to median arcuate ligament (MAL), without subsequent revascularization of celiac artery (CA) occlusion/stenosis.

Methods: Between January 1^st 2012 and June 1^st 2024, all records from adult patients (≥ 18 years old) referred to our hospital for TAE due to ruptured PDAAs were retrospectively reviewed. All referrals were based on emergency clinical decisions and computed tomography. Procedure data included procedure, type of embolic agent and per-procedural complication. TAE technical success was defined as the cessation of aneurysm opacification immediately after the TAE, based on angiographic findings. Overall technical success was defined as the cessation of aneurysm opacification after TAE or percutaneous salvage approach during the same session. Then, we analyzed all published original articles published between January 2007 and December 2024 on emergency TAE of ruptured PDAAs due to MAL, without subsequent treatment of CA stenosis/occlusion.

Results: Nine patients (4 males) were referred for TAE for ruptured PDAAs due to MAL in our center. TAE technical success was achieved in 7/9 patients, and overall technical success was achieved in all patients. There were no major complications. No patients had rebleeding during follow-up. We reviewed four retrospective studies including 29 patients treated for ruptured PDAAs due to MAL without subsequent treatment of CA stenosis/occlusion. No patient received additional treatment for CA stenosis/occlusion. No aneurysm recurrence was diagnosed during the reported follow-up periods ranging from 1 to 65 months.

Conclusion: TAE for ruptured PDAAs without CA revascularization is safe and should be considered, although further studies are required to validate its validity and long-term outcomes.