dr. lucas marcelo dias freire campinas-sp, brazil · dr. lucas marcelo dias freire i have the...
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Treatment of a pancreaticoduodenal arcade
aneurysm with a flow modulator stent
Dr. Lucas Marcelo Dias Freire
Campinas-SP, Brazil
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Disclosure
Speaker name:
Dr. Lucas Marcelo Dias Freire
I have the following potential conflicts of interest to report:
Consulting
Employment in industry
Stockholder of a healthcare company
Owner of a healthcare company
Other(s)
X I do not have any potential conflict of interest
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Case Report
• 64-year-old woman with history of controlled high blood pressure and previous smoker; presented with dyspepsia.
• Abdominal ultrasound: anechoic mass in the topography of the pancreatic head, measuring 3,0 cm in diameter, with arterial flow in the Doppler study.
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CT Scan
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CT Scan
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CT Scan
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CT Scan
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CT Scan
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CT Scan - anterior view
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CT Scan - posterior view
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Gastroduodenal Arcade aneurysms
• Uncommon lesions
• Significant risk of rupture
• Often associated with celiac axis stenosis/occlusion
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Gastroduodenal Arcade aneurysms
J Vasc Surg 2016;64:1734-40.
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Treatment options
• Open surgery, with aneurysm ligation and hepatic/splenic artery bypass (antegrade or retrograde) - invasive, risk of pancreatitis, etc.
• Coil embolization of the aneurysm - risk of hepatic and splenic ischemia, due to occlusion of the gastroduodenal arcade.
• Stent-graft: no adequate proximal neck.
J Vasc Surg. 2011 Jun;53(6):1696-8. Epub 2011 Apr 22.Eur J Vasc Endovasc Surg. 2007 Jun;33(6):670-5. Epub 2007 Feb 2.
Vascular. 2006 Mar-Apr;14(2):109-12.
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Multilayer Stent
• Self-expandable, 3D-braided wire tube, structured in several interlocked layers (Multilayer flow-modulating stent – Cardiatis; Isnes, Belgium)
• CE marked for peripheral vessels
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Multilayer Stent• Laminates flow, while reducing speed and
strength of hemodynamic vortices inside the
aneurysm (increasing residence time and
promoting thrombus formation).
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Multilayer Stent
Redirects flow toward the ostia of collaterals; the aneurysm collapses (shrinks) while the collaterals remain patent
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Angio
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Angio
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Angio
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Angio
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Angio
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3-Month Follow-up CT Scan
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3-Month Follow-up CT Scan
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3-Month Follow-up CT Scan
Pre: 13,6 cm3
Post: 6,0 cm3
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3-Month Follow-up CT Scan
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8-Month Follow-up CT Scan
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3-Month Follow-up CT Scan
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8-Month Follow-up CT Scan
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• Multicentric, prospective register, 2009-2010
• 54 patients
• Peripheral (35) and visceral aneurysms
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• Technical success: 100%
• 1 year mortality = 5,5%
• No ruptures
• Stent occlusion
• 1 year primary and secondary patency : 86,9% and 90,7%
• 1 year Branches patency: 96,1%
• 1 year aneurysm complete thrombosis: 93,3%
• Diameter reduction (1, 6 and 12 months): 15,5%, 3,8% and 11,0%
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Conclusion
• Pancreaticoduodenal arcade aneurysms are rare, but potentially fatal lesions
• Treatment is challenging, especially when associated with celiac trunk occlusion
• The Multilayer stent diverted the flow from the aneurysm to the superior mesenteric artery and preserved gastroduodenal circulation
• Longer-term follow-up is needed
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Treatment of a pancreaticoduodenal arcade
aneurysm with a flow modulator stent
Dr. Lucas Marcelo Dias Freire
Campinas-SP, Brazil