Celiomesenteric and renal common trunk associated with distal thoracic aorta coarctation and three saccular aneurysms Gabrielle Sarlon-Bartoli, MD, PhD,a,b Pierre Edouard Magnan, MD,a,b Hubert Lépidi, MD, PhD,b,c and Michel Alain Bartoli, MD, PhD,a,b Marseille, France
A 36-year-old woman was known to have an anomaly of distal thoracic aorta with coarctation associated with a celiomesenteric and left renal artery common trunk, discovered incidentally in 1985. She had no hypertension. Ultrasound follow-up was performed annually and diagnosed a saccular aneurysm with a maximal diameter of 11 mm. Before a future pregnancy, her gynecologist and her cardiologist referred her to our vascular department to prevent the potential risk of rupture during pregnancy and delivery. Arterial phased computed tomography specified anomalies with a hypoplasia of descending thoracic aorta (maximal diameter of 6 mm) just before diaphragmatic hiatus, a supradiaphragmatic birth of the celiomesenteric and left renal artery common trunk at the level of hypoplasia, two saccular aneurysms of 5-mm diameter at the ostium of the right renal artery, one saccular aneurysm on the left side of the aorta hypoplasia with a maximal diameter of 11 mm, and multiple development of intercostal arteries (A). This anomaly was confirmed with arteriography, and identification of spinal artery was performed (B). Surgery was performed with resection of hypoplasia and the aneurysms, aortoaortic graft bypass, and relocation of visceral arteries. Histology showed degenerative lesions of the media with cystic medial necrosis (arrow) and collagenic fibrosis (+) (C). Three-month postoperative computed tomography showed a good patency with the aorta graft and visceral arteries relocation without aneurysms (D). DISCUSSION Celiomesenteric trunk with development of aneurysms is a very rare situation, with 18 cases reported in the English literature.1,2 The relationship between a celiomesenteric anomaly and the formation of an aneurysm remains unclear. The absence of a celiac trunk and the excessive blood inflow into the origin of the anomalous branches were probably responsible for the aneurysm. An even rarer situation is the association of coarctation of the distal thoracic aorta with a supradiaphragmatic origin of a celiomesenteric trunk recently reported by Lee et al.3 We report here for the first time the combination of a distal thoracic aorta coarctation, a supradiaphragmatic celiomesenteric and renal common trunk, and three saccular aneurysms probably from congenital origin. REFERENCES 1. Wang Y, Chen P, Shen N, Yang JT, Chen JH, Zhang WG. Celiomesenteric trunk with concurrent aneurysm: report of a case. Surg Today 2010;40:477-81. 2. Higashiyama H, Yamagami K, Fujimoto K, Koshiba T, Kumada K, Yamamoto M. Open surgical repair using a reimplantation technique for a large celiac artery aneurysm anomalously arising from the celiomesenteric trunk. J Vasc Surg 2011;54:1805-7. 3. Lee Y, Lee W, Park JH, Ahn H. A coarctation of the distal thoracic aorta with a supradiaphragmatic origin of the celiacomesenteric trunk: an anatomic and etiologic description. Cardiovasc Intervent Radiol 2010;33:1033-5. Submitted Jul 31, 2012; accepted Jun 30, 2013.
From the Service de Chirurgie Vasculairea and Service d’Anatomo-Pathologie,c Assistance Publique Hôpitaux de Marseille, Hôpital de la Timone; and the Faculté de Médecine de Marseille, Aix-Marseille Université.b Author conflict of interest: none. E-mail: [email protected]. The editors and reviewers of this article have no relevant financial relationships to disclose per the JVS policy that requires reviewers to decline review of any manuscript for which they may have a conflict of interest. J Vasc Surg 2014;59:1432 0741-5214/$36.00 Copyright Ó 2014 by the Society for Vascular Surgery. http://dx.doi.org/10.1016/j.jvs.2013.06.088
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A 36-year-old woman was known to have an anomaly of distal thoracic aorta with coarctation associated with a celiomesenteric and left renal artery common trunk, discovered incidentally in 1985. She had no hypertension. Ultrasound follow-up was performed annually and diagnosed a saccular aneurysm with a maximal diameter of 11 mm. Before a future pregnancy, her gynecologist and her cardiologist referred her to our vascular department to prevent the potential risk of rupture during pregnancy and delivery. Arterial phased computed tomography specified anomalies with a hypoplasia of descending thoracic aorta (maximal diameter of 6 mm) just before diaphragmatic hiatus, a supradiaphragmatic birth of the celiomesenteric and left renal artery common trunk at the level of hypoplasia, two saccular aneurysms of 5-mm diameter at the ostium of the right renal artery, one saccular aneurysm on the left side of the aorta hypoplasia with a maximal diameter of 11 mm, and multiple development of intercostal arteries (A). This anomaly was confirmed with arteriography, and identification of spinal artery was performed (B). Surgery was performed with resection of hypoplasia and the aneurysms, aortoaortic graft bypass, and relocation of visceral arteries. Histology showed degenerative lesions of the media with cystic medial necrosis (arrow) and collagenic fibrosis (+) (C). Three-month postoperative computed tomography showed a good patency with the aorta graft and visceral arteries relocation without aneurysms (D). DISCUSSION Celiomesenteric trunk with development of aneurysms is a very rare situation, with 18 cases reported in the English literature.1,2 The relationship between a celiomesenteric anomaly and the formation of an aneurysm remains unclear. The absence of a celiac trunk and the excessive blood inflow into the origin of the anomalous branches were probably responsible for the aneurysm. An even rarer situation is the association of coarctation of the distal thoracic aorta with a supradiaphragmatic origin of a celiomesenteric trunk recently reported by Lee et al.3 We report here for the first time the combination of a distal thoracic aorta coarctation, a supradiaphragmatic celiomesenteric and renal common trunk, and three saccular aneurysms probably from congenital origin. REFERENCES 1. Wang Y, Chen P, Shen N, Yang JT, Chen JH, Zhang WG. Celiomesenteric trunk with concurrent aneurysm: report of a case. Surg Today 2010;40:477-81. 2. Higashiyama H, Yamagami K, Fujimoto K, Koshiba T, Kumada K, Yamamoto M. Open surgical repair using a reimplantation technique for a large celiac artery aneurysm anomalously arising from the celiomesenteric trunk. J Vasc Surg 2011;54:1805-7. 3. Lee Y, Lee W, Park JH, Ahn H. A coarctation of the distal thoracic aorta with a supradiaphragmatic origin of the celiacomesenteric trunk: an anatomic and etiologic description. Cardiovasc Intervent Radiol 2010;33:1033-5. Submitted Jul 31, 2012; accepted Jun 30, 2013.
From the Service de Chirurgie Vasculairea and Service d’Anatomo-Pathologie,c Assistance Publique Hôpitaux de Marseille, Hôpital de la Timone; and the Faculté de Médecine de Marseille, Aix-Marseille Université.b Author conflict of interest: none. E-mail: [email protected]. The editors and reviewers of this article have no relevant financial relationships to disclose per the JVS policy that requires reviewers to decline review of any manuscript for which they may have a conflict of interest. J Vasc Surg 2014;59:1432 0741-5214/$36.00 Copyright Ó 2014 by the Society for Vascular Surgery. http://dx.doi.org/10.1016/j.jvs.2013.06.088
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