Rupture of true aneurysms of the pancreaticoduodenal arcade: Treatment with transcatheter arterial embolization

We present 2 cases of ruptured true aneurysms of the pancreaticoduodenal arcade, underscoring the role of transcatheter arterial embolization (TAE) as the initial treatment of choice in pancreaticoduodenal arcade aneurysm. Ruptured true aneurysms of the pancreaticoduodenal artery (PDA) are uncommon and few cases have been reported, whereas false aneurysms are seen more often. The first patient we describe is a 63-year-old woman with an aneurysm of the PDA initially treated by TAE. The second case is a 67-year-old woman with an aneurysm of the inferior PDA postoperatively treated by TAE. In both patients TAE via a combined superior mesenteric artery and celiac axis approach was successful. Follow-up contrast-enhanced computed tomography showed prolonged occlusion of both aneurysms. A review of the literature concerning TAE supports our experience that TAE of ruptured aneurysms of the pancreaticoduodenal arcade, when feasible, is at least as effective as conventional surgery, but with lower morbidity and mortality. Therefore, TAE should be the initial treatment of choice in this group of patients.