Celiac artery stenosis and cephalic duodenopancreatectomy: An undervalued risk?

Muros, José; Soriano, Jordi; Codina-Barreras, Antoni; Planellas, Pere; López‐Ben, Santiago; Albiol, Maite; Falgueras, Laia; Castro, Ernesto; Pigem, Anna; Maroto, Albert; Figueras, Joan

doi:10.1016/s2173-5077(11)70030-8

Cited by 2 publications

(4 citation statements)

References 25 publications

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“…If untreated, coeliac artery stenosis in a patient undergoing PD can lead to severe consequences, including increased risk of pancreatic or bile leakage, gastric and hepatic ischemia, and death [ 52 , 53 ]. Zhou et al reported a significantly increased risk of biliary fistula after PD in CAS (27% vs 2.6%) [ 54 ].…”

Section: Reviewmentioning

confidence: 99%

Pancreaticoduodenectomy in Patients With Coeliac or Superior Mesenteric Artery Stenosis: A Review of the Literature

Nawara,

Albendary

2024

Cureus

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Pancreaticoduodenectomy (Whipple’s procedure) is a technically demanding operation performed for malignant and premalignant conditions of the pancreatic head, duodenum and bile duct. Awareness of the vascular anatomy, variations, and pathology of this area is essential to achieve safe surgery and good outcomes. The operation involves division of the gastroduodenal artery (GDA) which provides communication between the foregut and midgut blood supply. In patients with coeliac or superior mesenteric artery (SMA) stenosis, this can lead to reduced blood supply to the foregut or midgut organs, with consequent severe ischaemic complications leading to significant morbidity and mortality. Coeliac artery stenosis is caused by median arcuate ligament syndrome (MALS) in the majority of patients with atherosclerosis being the second most common cause. SMA stenosis is much less common and is caused in the majority of cases by atherosclerosis. A review of preoperative imaging and intraoperative gastroduodenal artery clamp test is important to identify cases that may need additional procedures to preserve the blood supply. In this paper, we present a literature review for studies reporting patients undergoing Whipple’s operation with concomitant coeliac axis stenosis (CAS) or SMA stenosis. Analysis of causes of stenosis or occlusion, prevalence, risk factors, different management strategies and outcomes was conducted.

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Section: Reviewmentioning

confidence: 99%

Pancreaticoduodenectomy in Patients With Coeliac or Superior Mesenteric Artery Stenosis: A Review of the Literature

Nawara,

Albendary

2024

Cureus

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“…The most frequently described HAAV are an anomalous RHA from the SMA (10%-21%), a displaced left HA (LHA) from the left gastric artery (4%-10%), displaced RHA and LHA, an accessory RHA and/or LHA (1%-8%), a displaced CHA from the SMA or aorta (0.4%-4.5%), and quadrifurcation of the HA itself [20,23] . In the largest study carried out to date, which included 5002 abdominal CT, the crucial data regarding identification of HAAV during PD were the following: only 0.13% of patients with CHA originating in the celiac axis (normal anatomy) had a retroportal or transpancreatic course; CHA originating in the aorta always had a normal course, and CHA coming from the SMA might show different relations with the pancreas (supra, trans or infrapancreatic) and the PV and SMV (pre or retroportal and nificance due to collateral pathways [26][27][28] . CAS has been reported in 2%-7.6% of patients undergoing PD [23] .…”

Section: Hepatic Artery Anatomical Variationsmentioning

confidence: 99%

“…CAS has been reported in 2%-7.6% of patients undergoing PD [23] . In these patients, upper abdominal organs are at risk of necrosis from ischemia because PD resection involves the collateral vessels (the gastroduodenal and pancreaticoduodenal arteries) [19,24,[26][27][28] . The cause of CAS may be vascular (mainly arteriosclerosis) or non-vascular: compression of the median arcuate ligament (MAL) or invasion by tumor or lymph nodes [23,26,27] .…”

Section: Hepatic Artery Anatomical Variationsmentioning

confidence: 99%

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Tricks and tips in pancreatoduodenectomy

Pallisera

Morales

Ramia

2014

WJGO

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Author contributions: Pallisera A wrote the introduction and the section on the artery-first approach; Ramia JM wrote the section on arterial complications during pancreatoduodenectomy; Morales R wrote the section on extended lymphadenectomy for pancreatic head adenocarcinoma. AbstractPancreaticoduodenectomy (PD) is the standard surgical treatment for tumors of the pancreatic head, proximal bile duct, duodenum and ampulla, and represents the only hope of cure in cases of malignancy. Since its initial description in 1935 by Whipple et al , this complex surgical technique has evolved and undergone several modifications. We review three key issues in PD: (1) the initial approach to the superior mesenteric artery, known as the artery-first approach; (2) arterial complications caused by anatomic variants of the hepatic artery or celiac artery stenosis; and (3) the extent of lymphadenectomy.

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Celiac artery stenosis and cephalic duodenopancreatectomy: An undervalued risk?

Cited by 2 publications

References 25 publications

Pancreaticoduodenectomy in Patients With Coeliac or Superior Mesenteric Artery Stenosis: A Review of the Literature

Pancreaticoduodenectomy in Patients With Coeliac or Superior Mesenteric Artery Stenosis: A Review of the Literature

Tricks and tips in pancreatoduodenectomy

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