Despite Improving Outcomes in the Open Repair of Ruptured and Non-Ruptured Pancreaticoduodenal Artery Aneurysms, Endovascular Management is Better.
Stuart L. Blackwood, MD1, Mohammad S. Sheikh, MD2, Alan M. Dietzek, MD, FACS, RVPI3.
1Brigham and Womens hospital, Boston, MA, USA, 2University of Kentucky, Lexington, KY, USA, 3Danbury Hospital, Danbury, CT, USA.
Objective(s): Pancreaticoduodenal artery aneurysms are rare visceral aneurysms which have been reported traditionally with high mortality rates when ruptured. Through an extensive review of the entire English literature to date, this study reports both historic and contemporary outcomes of endovascular and open repair of these uncommon aneurysms.
Methods: A comprehensive search of all articles and a review of their references was undertaken to identify all pancreaticoduodenal artery aneurysms reported from 1895 to present. We searched PubMed, Medline, Google Scholar, and Google databases for the keywords “pancreaticoduodenal artery aneurysm”, “PDAA” “visceral artery aneurysms”. Language was not a limitation unless the paper could not be translated into English or lacked critical data for analysis.
Results: A total of 187 articles with 274 distinct patients were identified, 18 were excluded due to missing data or inability to translate the articles into English. 256 patients were identified for analysis of which 41% were female, and 59% male. Co-existent celiac artery stenosis or occlusion was identified in 60% of all identified patients. The most common co-existent illnesses were HTN (20%) and chronic pancreatitis (10%). Of the 253 cases in which presentation was reported 48% (n=122) presented emergently as a ruptured aneurysm with an overall mortality of 24% (29/122). Repair of ruptured PDAA aneurysms carried a higher mortality rate of 29% (15/51) open compared to 4.8% (3/62) when treated by endovascular techniques (P<0.05). Post 2000, 67 patients of 160 in total were identified as ruptured on presentation (41%). Mortality in the post 2000 ruptured aneurysm cohort was 23% for open repair (3/13) vs 5.5% (3/54) in the endovascular group.
Conclusions: Successful management of these aneurysms has been achieved using a variety of conventional surgical and endovascular therapies in both emergent and non-emergent settings. Studies published in the 21st century suggest improve diagnostic capabilities and a significant improvement in survival using an endovascular approach vs open surgery. Open surgical techniques nonetheless remain a viable option when endovascular therapy is either not available or fails to control hemorrhage.
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