@meely
Back from Hopkins. They believe aneurysm arises from Pancreaticoduodenal arcade, and not an arc of Buhler. In my case the pancreaticoduodenal artery is a single vessel, not a pared vessel (anterior and posterior branches). If it was a paired vessel, they could simply occlude the branch with the aneurysm. This option is not available given the single collateral route. They believe risk of treating the aneurysm far outweighs benefit at this point in time. They recommended one year follow-up with re-evaluation of risk benefit ratio. They will be more concerned with rate of growth of the aneurysm as opposed to absolute size. They did not recommend any precautions. The most reassuring thing they told me is that a sudden catastrophic hemorrhage is very unlikely. They stated it is much more likely that the aneurysm would present with a small "sentinel bleed" (small micro-puncture which spontaneously heals itself). This would be very painful, and and send to the ER. A CT angiogram would then be obtained which would show a small perianeurysmal hemorrhage. This would then given the surgeons and interventional radiologists time to plan a treatment.
My collateral vessel is quite tortuous (see attached photo), thus treating any aneurysm via coils or exclusionary stent would be quite difficult.