Characteristic and endovascular management of peripancreatic arterial aneurysms: Experience from a single-center cohort study

Objective Peripancreatic arterial aneurysms (PAAs) are rare but associated with a high risk of rupture and significant mortality. This study aims to evaluate the safety and efficacy of endovascular management for PAAs, focusing on technical strategies and midterm outcomes. Methods A single-center retrospective analysis was conducted on a study cohort of 26 patients with PAAs treated consecutively between June 2014 and March 2025. Endovascular therapy was prioritized, with open repair reserved for anatomically complex cases. Technical success, procedural details, and follow-up outcomes were analyzed. Results Among 29 aneurysms in 26 patients, 15 were located at the gastroduodenal artery–superior pancreaticoduodenal artery (GDA-SPDA) and 14 were at the superior mesenteric artery–inferior pancreaticoduodenal artery (SMA-IPDA). Endovascular therapy achieved primary technical success in 88.5% of cases. Two patients failed endovascular access via both the CA and SMA. Another had a vascular variant creating a high risk of splenic ischemia upon embolization, and a fourth had an aneurysm involving critical duodenal branches. Three of these four patients underwent successful open surgical repair. Sac-only embolization was performed in 63.6% of cases to preserve collateral flow. Access routes were largely determined by aneurysm location, with SMA for SMA-IPDA aneurysms and celiac artery (CA) for GDA-SPDA aneurysms ( p < 0.001). Concomitant celiac revascularization was avoided in most cases. At a median follow-up of 48 months, aneurysm recurrence and restenosis rates were 4.0% each, with no coil migrations or ischemic complications. Conclusion Tailored endovascular strategies guided by aneurysm anatomy and collateral circulation yield high technical success and favorable midterm outcomes without routine celiac revascularization. Endovascular therapy is a safe and effective first-line approach for PAAs, with open repair reserved for complex anatomies.