Treatment of a pancreaticoduodenal artery aneurysm with greater saphenous vein bypass for preservation of hepatic flow in a patient with celiac occlusion

A 62-year-old woman presented with epigastric pain and elevated liver function test results. Magnetic resonance cholangiopancreatography showed a 10-mm common bile duct, with a 3-cm aneurysm in what was believed to be from the superior mesenteric artery. Follow-up computed tomography angiography showed that this was actually from the inferior pancreaticoduodenal artery. The celiac artery had a flush occlusion. A major collateral pathway was present between the inferior and superior pancreaticoduodenal arteries, which supplied the hepatic and splenic circulation. Open surgery with aneurysm resection and bypass from the infrarenal aorta to the normal inferior pancreaticoduodenal artery using saphenous vein was performed.