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Int J Angiol 2015; 24(01): 63-66
DOI: 10.1055/s-0033-1354306
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Polyarteritis Nodosa-Induced Pancreaticoduodenal Artery Aneurysmal Rupture

Steven Levin
1   Division of Vascular Surgery, University of Minnesota Medical Center, Minneapolis, Minnesota
,
John Graber
2   Division of Vascular Surgery, Abbott Northwestern Hospital, Minneapolis, Minnesota
,
Eduardo Ehrenwald
2   Division of Vascular Surgery, Abbott Northwestern Hospital, Minneapolis, Minnesota
,
Nedaa Skeik
2   Division of Vascular Surgery, Abbott Northwestern Hospital, Minneapolis, Minnesota
› Author Affiliations
Further Information

Publication History

Publication Date:
13 October 2013 (online)

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Abstract

Polyarteritis nodosa (PAN) is a systemic, necrotizing vasculitis of small- and medium-sized arteries typically with multiorgan involvement. Most cases of PAN are idiopathic, although hepatitis B or C virus infections and hairy cell leukemia are important in the pathogenesis of some cases. PAN is characterized as segmental transmural inflammation of muscular arteries. Diagnosis is based on clinical suspicion, a negative immunofluorescence test for antineutrophil cytoplasmic antibodies, and whenever possible, biopsy conformation. Angiographic images may reveal microaneurysms affecting the renal, hepatic, or mesenteric vasculature. Aneurysmal formation and rupture are important complications that can be fatal. Treatment may warrant immunosuppression with steroids and cyclophosphamide. If left untreated, PAN can be fatal. To our knowledge, we report the second documented case of PAN-induced ruptured inferior pancreaticoduodenal artery aneurysm.

Keywords

aneurysm - arteritis - coil embolization - C-reactive protein - mesenteric artery - vasculitis - vessel repair
 

  • References

  • 1 Jennette JC, Falk RJ, Bacon PA , et al. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum 2013; 65 (1) 1-11
    CrossrefPubMedGoogle Scholar
  • 2 Parent BA, Cho SW, Buck DG, Nalesnik MA, Gamblin TC. Spontaneous rupture of hepatic artery aneurysm associated with polyarteritis nodosa. Am Surg 2010; 76 (12) 1416-1419
    PubMedGoogle Scholar
  • 3 Herskowitz MM, Flyer MA, Sclafani SJ. Percutaneous transhepatic coil embolization of a ruptured intrahepatic aneurysm in polyarteritis nodosa. Cardiovasc Intervent Radiol 1993; 16 (4) 254-256
    CrossrefPubMedGoogle Scholar
  • 4 Nakashima M, Suzuki K, Okada M, Takada K, Kobayashi H, Hama Y. Successful coil embolization of a ruptured hepatic aneurysm in a patient with polyarteritis nodosa accompanied by angioimmunoblastic T cell lymphoma. Clin Rheumatol 2007; 26 (8) 1362-1364
    CrossrefPubMedGoogle Scholar
  • 5 Suzuki K, Tachi Y, Ito S , et al. Endovascular management of ruptured pancreaticoduodenal artery aneurysms associated with celiac axis stenosis. Cardiovasc Intervent Radiol 2008; 31 (6) 1082-1087
    CrossrefPubMedGoogle Scholar
  • 6 Peddi P, Kalavakunta JK, Annakula M, Armstrong JR. An unusual complication of polyarteritis nodosa with massive retroperitoneal hemorrhage: a case report. Int Arch Med 2010; 3 (3) 31
    CrossrefPubMedGoogle Scholar
  • 7 Camilleri M, Pusey CD, Chadwick VS, Rees AJ. Gastrointestinal manifestations of systemic vasculitis. Q J Med 1983; 52 (206) 141-149
    PubMedGoogle Scholar
  • 8 Guillevin L, Lhote F, Gherardi R. Polyarteritis nodosa, microscopic polyangiitis, and Churg-Strauss syndrome: clinical aspects, neurologic manifestations, and treatment. Neurol Clin 1997; 15 (4) 865-886
    CrossrefPubMedGoogle Scholar
  • 9 Sellke FW, Williams GB, Donovan DL, Clarke RE. Management of intra-abdominal aneurysms associated with periarteritis nodosa. J Vasc Surg 1986; 4 (3) 294-298
    CrossrefPubMedGoogle Scholar
  • 10 Rits Y, Oderich GS, Bower TC , et al. Interventions for mesenteric vasculitis. J Vasc Surg 2010; 51 (2) 392-400, e2
    CrossrefPubMedGoogle Scholar
  • 11 Tarhan NC, Coskun M, Kayahan EM, Yildirim E, Yucel E. Regression of abdominal visceral aneurysms in polyarteritis nodosa: CT findings. AJR Am J Roentgenol 2003; 180 (6) 1617-1619
    CrossrefPubMedGoogle Scholar
  • 12 Drury MI, Hickey MD, Malone JP. A case of polyarteritis nodosa treated with cortisone. BMJ 1951; 2 (4746) 1487-1489
    CrossrefPubMedGoogle Scholar
  • 13 Yousefzadeh DK, Chow KC, Benson CA. Polyarteritis nodosa: regression of arterial aneurysms following immunosuppressive and corticosteroid therapy. Pediatr Radiol 1981; 10 (3) 139-141
    CrossrefPubMedGoogle Scholar
  • 14 Leib ES, Restivo C, Paulus HE. Immunosuppressive and corticosteroid therapy of polyarteritis nodosa. Am J Med 1979; 67 (6) 941-947
    CrossrefPubMedGoogle Scholar
  • 15 Guillevin L, Lhote F, Gayraud M , et al. Prognostic factors in polyarteritis nodosa and Churg-Strauss syndrome. A prospective study in 342 patients. Medicine (Baltimore) 1996; 75 (1) 17-28
    CrossrefPubMedGoogle Scholar
  • 16 Stanley JC, Wakefield TW, Graham LM, Whitehouse Jr WM, Zelenock GB, Lindenauer SM. Clinical importance and management of splanchnic artery aneurysms. J Vasc Surg 1986; 3 (5) 836-840
    CrossrefPubMedGoogle Scholar
  • 17 Bowens NM, Woo EY, Fairman RM. Reno-hepatic artery bypass for an inferior pancreaticoduodenal artery aneurysm with associated celiac occlusion. J Vasc Surg 2011; 53 (6) 1696-1698
    CrossrefPubMedGoogle Scholar
  • 18 Katsura M, Gushimiyagi M, Takara H, Mototake H. True aneurysm of the pancreaticoduodenal arteries: a single institution experience. J Gastrointest Surg 2010; 14 (9) 1409-1413
    CrossrefPubMedGoogle Scholar
  • 19 Brocker JA, Maher JL, Smith RW. True pancreaticoduodenal aneurysms with celiac stenosis or occlusion. Am J Surg 2012; 204 (5) 762-768
    CrossrefPubMedGoogle Scholar
  • 20 Kalva SP, Athanasoulis CA, Greenfield AJ , et al. Inferior pancreaticoduodenal artery aneurysms in association with celiac axis stenosis or occlusion. Eur J Vasc Endovasc Surg 2007; 33 (6) 670-675
    CrossrefPubMedGoogle Scholar
  • 21 Flood K, Nicholson AA. Inferior pancreaticoduodenal artery aneurysms associated with occlusive lesions of the celiac axis: diagnosis, treatment options, outcomes, and review of the literature. Cardiovasc Intervent Radiol 2013; 36 (3) 578-587
    CrossrefPubMedGoogle Scholar
  • 22 Bellosta R, Luzzani L, Carugati C, Melloni C, Sarcina A. Pancreaticoduodenal artery aneurysms associated with celiac axis occlusion. Ann Vasc Surg 2005; 19 (4) 534-539
    CrossrefPubMedGoogle Scholar
  • 23 Ducasse E, Roy F, Chevalier J , et al. Aneurysm of the pancreaticoduodenal arteries with a celiac trunk lesion: current management. J Vasc Surg 2004; 39 (4) 906-911
    CrossrefPubMedGoogle Scholar
  • 24 Sugiyama K, Takehara Y. Analysis of five cases of splanchnic artery aneurysm associated with coeliac artery stenosis due to compression by the median arcuate ligament. Clin Radiol 2007; 62 (7) 688-693
    CrossrefPubMedGoogle Scholar
  • 25 Hildebrand P, Esnaashari H, Franke C, Bürk C, Bruch HP. Surgical management of pancreaticoduodenal artery aneurysms in association with celiac trunk occlusion or stenosis. Ann Vasc Surg 2007; 21 (1) 10-15
    CrossrefPubMedGoogle Scholar
  • 26 Williamson JM, Cook JL, Jackson JE, Hocken DB. Infective aneurysm of the inferior pancreaticoduodenal artery. Ann R Coll Surg Engl 2011; 93 (6) e87-e88
    CrossrefPubMedGoogle Scholar
  • 27 Li Destri G, Innao V, Petrillo G, Di Cataldo A. A rare pancreatic pseudoaneurysm in patient with acute pancreatitis and multiple myeloma. Ann Ital Chir 2011; 82 (4) 301-304
    PubMedGoogle Scholar
  • 28 Sethi H, Peddu P, Prachalias A , et al. Selective embolization for bleeding visceral artery pseudoaneurysms in patients with pancreatitis. Hepatobiliary Pancreat Dis Int 2010; 9 (6) 634-638
    PubMedGoogle Scholar
  • 29 Leong BD, Chuah JA, Kumar VM, Mazri MY, Zainal AA. Successful endovascular treatment of post-traumatic inferior pancreaticoduodenal artery pseudoaneurysm. Singapore Med J 2008; 49 (11) e300-e302
    PubMedGoogle Scholar