PMC5549485_01
Contrast-enhanced CT scan of the abdomen prior to transarterial embolization: A 2.0- x 1.4 cm visceral aneurysm (Arrow) surrounded by 0.7 cm rim of thrombus arising from the inferior pancreaticoduodenal branch. The hemoperitoneum is also noticed in this figure (Asterisk).
CRIRA2017-6989673.001.jpg
PMC5549485_01_CRIRA2017-6989673.001.jpg
fig1
Contrast-enhanced computed tomography (CT) of the abdomen and pelvis showed a 2.0- x 1.4-cm visceral aneurysm, surrounded by a 0.7 cm rim of thrombus, arising from the inferior pancreaticoduodenal branch of the superior mesenteric artery (SMA), in addition to a moderate hemoperitoneum (Figure 1).
Evidence of celiac trunk stenosis: Sagittal reconstruction of contrast-enhanced CT scan of abdomen revealing the evidence of stenosis at the take-off of the celiac trunk (Arrow).
CRIRA2017-6989673.002.jpg
PMC5549485_01_CRIRA2017-6989673.002.jpg
fig2
The aneurysm was associated with severe celiac trunk stenosis (Figure 2).
Coronal reconstruction revealing patent portal vein (Arrowhead) with compression of confluence by the aneurysm: filling of the aneurysm with contrast is shown with its respective compression on the confluence of the superior mesenteric vein and the portal vein (Arrow).
CRIRA2017-6989673.003.jpg
PMC5549485_01_CRIRA2017-6989673.003.jpg
fig3
The compression by the aneurysm caused almost complete occlusion of the confluence of the splenic and superior mesenteric veins; however, the portal vein was widely patent (Figure 3).
Selective digital subtraction angiography (DSA) of the superior mesenteric artery: (a) A 2.0- x 1.4-cm narrow neck oblong aneurysm (Arrow) originating from the anterior branch of the inferior pancreaticoduodenal artery. Note the several collaterals originating from the superior mesenteric artery and the retrograde filling of the hepatic artery (Curved arrow) through the pancreaticoduodenal arcade. (b) Three-dimensional reconstruction of the enhanced CT images revealing the oblong aneurysm (Arrow), originating from a branch of the superior mesenteric artery. Note the stenosis at the origin of the celiac trunk (Curved arrow).
CRIRA2017-6989673.004.jpg
PMC5549485_01_CRIRA2017-6989673.004.jpg
fig4
Filling of a single visceral aneurysm originating from an anterior branch of the Inferior PDA (Figures 4(a) and 4(b)) was observed.
Selective angiography after coil embolization: (a) Microcoils (Arrow) proximal and distal to the origin of the aneurysm. Adequate retrograde collaterals to the liver through the posterior branch are also shown (Curved arrow). (b) Three-dimensional reconstruction on follow-up CT scan, showing persistent occlusion of the aneurysm, with patent hepatic artery.
CRIRA2017-6989673.005.jpg
PMC5549485_01_CRIRA2017-6989673.005.jpg
fig5
The parent artery was measured at 4 mm in diameter and was then embolized by advancing a 2.8-F Prograte microcatheter (Terumo Interventional Systems) beyond the neck of the aneurysm and the placement of five interlocking 4 mm fibred platinum microcoils (Cook, Bloomingdale, USA), using the "back door-front door" approach, distal, across, and proximal to the origin of the aneurysm (Figure 5(a)).