Acute pancreatitis caused by pancreatic ischemia after TEVAR combined with intentional celiac artery coverage and embolization of the branches of the celiac artery

Kawatani, Yohei; Kurobe, Hirotsugu; Nakamura, Yoshitsugu; Suda, Yuji; Okuma, Yoshinori; Sato, Shin-ichiro; Hashimoto, Toru; Hori, Takaki

doi:10.1093/jscr/rjx029

Cited by 10 publications

(4 citation statements)

References 7 publications

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“…12 The SMA contributes collateral perfusion to the celiac artery distribution primarily through the pancreaticoduodenal arcade (inclusive of the gastroduodenal artery) and the dorsal pancreatic artery. 13 Occlusion or ligation of the celiac artery can subsequently lead to ischemic pancreatitis, 14 hepatitis, 3,6 cholangiopathy, 3 and acute or chronic bowel ischemia. 15 SCI becomes a concern during CAO due to endograft coverage at spinal levels T12-L1, 16 potentially compromising collateral spinal perfusion via the artery of Adamkiewicz at T10-L2 17 and intercostal arteries, which branch along the thoracic aorta.…”

Section: Discussionmentioning

confidence: 99%

Occlusion of the Celiac Artery during Endovascular Thoracoabdominal Aortic Aneurysm Repair Is associated with Increased Perioperative Morbidity and Mortality

King

Gedney

Ruddy

et al. 2020

Annals of Vascular Surgery

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Background: Some studies suggest that celiac artery coverage during elective endovascular thoracoabdominal aortic aneurysm (TAAA) repair is safe given sufficient collateralization of visceral organ perfusion from the superior mesenteric artery. However, there is concern that celiac artery coverage may lead to increased risk of foregut or spinal cord ischemia with an attendant increased risk of mortality. We sought to investigate rates of bowel ischemia, spinal cord ischemia, and 30-day mortality associated with celiac artery coverage during TEVAR and complex EVAR. Methods: The Society for Vascular Surgery Vascular Quality Initiative database was queried for TEVAR and complex EVAR cases from 2012 to 2018. Inclusion criteria included TAAA pathology and endograft extension to aortic zone 6. Patients with aortic rupture, trauma, prior thoracic aortic surgery, known preoperative occlusion of the left subclavian superior mesenteric, or celiac arteries were excluded. Cases with intraoperative celiac artery occlusion (CAO) were compared retrospectively to cases with celiac artery preservation (CAP). Primary outcomes included 30-day mortality and a composite end point of 30-day mortality, spinal cord ischemia (transient or permanent lower extremity neurologic deficit), and bowel ischemia (colonoscopic evidence of ischemia, bloody stools in a patient who dies prior to colonoscopy or laparotomy, or other documented clinical diagnosis). Univariable comparisons were performed using chisquared tests and Student's t-tests, as appropriate. Multivariable logistic regression analyses were employed to identify independent predictors of outcome. Results: There were 628 cases identified for inclusion in the study. Patients undergoing CAO (n = 44) were more likely to be female or to have higher rates of preoperative spinal drain use, American Society of Anesthesiologists score ≥3, low preop hemoglobin, and/or symptomatic presentation, but fewer mean number of aortic zones covered. CAO was associated with higher 30day mortality (5 of 44, 11%) compared to CAP (23 of 584, 4%), P = 0.039. The composite end point occurred at a significantly greater proportion for those who had CAO (10 of 44, 23%

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Section: Discussionmentioning

confidence: 99%

Occlusion of the Celiac Artery during Endovascular Thoracoabdominal Aortic Aneurysm Repair Is associated with Increased Perioperative Morbidity and Mortality

King

Gedney

Ruddy

et al. 2020

Annals of Vascular Surgery

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“…Insufficient vascularization can lead to dysfunction of the pancreas such as pancreatitis and explain the patient's clinical picture. Therefore, examination of pancreatic vascularization using basic imaging diagnostics after the diagnosis of this type of SMA could benefit the patient (Kawatani et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

Classification of the superior mesenteric artery

Balcerzak

Tubbs

Waśniewska-Włodarczyk

et al. 2022

Clinical Anatomy

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The aim of this study was to characterize the branching pattern and morphology of the superior mesenteric artery (SMA), and also to create a new SMA classification, which seems necessary for clinicians performing surgery in this anatomical area. The anatomical variations in the branching patterns of the SMA were examined in 30 cadavers fixed in 10% formalin. Morphometric measurements were then obtained twice by two researchers. In the proposed classification system, Type I, characterized by all normal branches—inferior pancreatoduodenal artery, ileocolic artery, right colic artery, middle colic artery and intestinal arteries—occurred in 53.33% of the specimens. Type II, characterized by absence of the inferior pancreatoduodenal artery, was present in 26.67%. Type III, characterized by absence of the right colic artery, was present in 3.33%. Type IV, characterized by a common trunk for the inferior pancreatoduodenal artery and middle colic arteries, was observed in 3.33%. Type V, characterized by an aberrant hepatic artery and absence of the inferior pancreatoduodenal artery, was observed in 13.33%. The origin of the SMA was at the Th12/L1 level in 10% of cases, at L1 in 43.33%, at L1/L2 in 36.67%, and at L2 in 10%. The SMA is characterized by high morphological variability, the variants being associated with distinct clinical aspects. The introduction of a new, structured, anatomical classification seems necessary for all clinicians.

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“…Pancreatic ischemia of even short duration is a well-established factor for the development of acute pancreatitis [ 2 - 3 ]. In cases of ischemia, elevation of pancreatic enzymes may not be present immediately due to the development of massive pancreatic necrosis [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

A Case of Acute Pancreatitis in Hemolysis, Elevated Liver Enzymes, and Low Platelets Syndrome

Herrera

Oaks

Brensilver

2018

Cureus

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We present a case of hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome complicated by acute pancreatitis that responded favorably to conservative measures. The microvascular abnormalities and heightened inflammatory state present in HELLP syndrome and severe preeclampsia might be responsible for pancreatic ischemia or cytokine-induced pancreatic damage, which could result in acute pancreatitis.

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Acute pancreatitis caused by pancreatic ischemia after TEVAR combined with intentional celiac artery coverage and embolization of the branches of the celiac artery

Cited by 10 publications

References 7 publications

Occlusion of the Celiac Artery during Endovascular Thoracoabdominal Aortic Aneurysm Repair Is associated with Increased Perioperative Morbidity and Mortality

Occlusion of the Celiac Artery during Endovascular Thoracoabdominal Aortic Aneurysm Repair Is associated with Increased Perioperative Morbidity and Mortality

Classification of the superior mesenteric artery

A Case of Acute Pancreatitis in Hemolysis, Elevated Liver Enzymes, and Low Platelets Syndrome

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