The association between pancreaticoduodenal artery
aneurysm (
PDAA) and local hemodynamic changes in pancreaticoduodenal arcades is well established. However, there are few case reports of
PDAA associated with acute
aortic dissection. In this article, we outline and discuss the case of a 61-year-old man diagnosed with a type A acute
aortic dissection who underwent emergency surgery and developed sudden-onset severe
abdominal pain and
shock 10 days later. Contrast-enhanced computed tomography showed a ruptured
PDAA with feeding vessels from the gastroduodenal and superior mesenteric arteries, with evidence that the celiac artery was diverged from a false lumen. Transarterial embolization via the superior mesenteric artery alone was not expected to achieve hemostasis, so we performed a hybrid procedure involving transarterial embolization cannulated from superior mesenteric artery with complementary surgical
ligation of the gastroduodenal artery. The postoperative course was uneventful, and follow-up contrast-enhanced computed tomography showed no persistence of the
aneurysm 8 days after the second operation. This case proposed that visceral arterial malperfusion due to acute
aortic dissection can cause
PDAA in the early postoperative period. Although previous reports suggest that endovascular treatment is preferable, it may not always be feasible. Since ruptured PDAAs are often not detected during surgery, surgical treatment can be overly invasive. Whereas, transarterial embolization with complementary clamping or
ligation of the gastroduodenal artery for ruptured
PDAA is less invasive and can control
hemorrhage, especially when cannulation to the celiac artery is impossible. Notably, the technique did not cause organ
ischemia, presumably because the small collateral vessels of the pancreaticoduodenal arcades permitted sufficient blood flow. If endovascular treatment is unable to achieve rapid hemostasis, this technique may be a useful option for ruptured
PDAA.