Celiac axis stenosis in pancreaticoduodenectomy

Kurosaki, Isao; Hatakeyama, Katsuyoshi; Nihei, Kouei; Oyamatsu, Manabu

doi:10.1007/s00534-003-0871-6

Cited by 62 publications

(53 citation statements)

References 12 publications

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“…Arcari (2004) reported that there is a strong association between mitral valve prolapse and CACS. In addition, CACS has been reported in cases of: pancreaticoduonectomy (Kurosaki et al, 2004), duodenal carcinoma (Hayashibe et al, 2005), aortic dissection (Fujisawa et al, 2005), papillary neoplasm of the pancreas (Shima et al, 2005), nutcracker syndrome (Linares et al, 2002), abdominal trauma (Schreiber et al, 1998), carcinoma of the head of the pancreas (Doke et al, 1995), sarcoidosis (Stamler et al, 1989), and aneurysms of small pancreatic arteries (Proud and Chamberlain, 1978).…”

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confidence: 96%

Clinical anatomy of celiac artery compression syndrome: A review

et al. 2007

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Anatomic variations are often responsible for a variety of clinical conditions. In this review we investigate compression of the celiac artery and the superior mesenteric artery by the median arcuate ligament (MAL), diaphragmatic crura, or the celiac nerve plexus. This clinical condition known as celiac artery compression syndrome (CACS) has proven controversial in definition and relevance. This condition was first described as chronic abdominal pain because of the mesenteric ischemia caused by extrinsic compression of the celiac artery. Dunbar and others presented surgical approaches to decompress the celiac artery by releasing the MAL. Definitive answers have been sought to classify and relieve the clinical symptoms patients experience postprandially. Persistent symptoms following surgical treatment for CACS have led investigators to question the existence of this disease. Advances in technology such as angiographic MRI and color duplex ultrasonography have refreshed the importance of considering compression of the celiac artery during differential diagnoses. Because of the varying anatomic etiologies of disease, it is not possible to pinpoint a single cause for CACS. Potential etiologies for compression of the celiac artery include a "high take off" origin of the celiac artery compressed by normal diaphragmatic crura and MAL, a normal origin of the celiac artery with long diaphragmatic crura and MAL, large bilaterally fused celiac ganglia (with or without the involvement of the superior mesenteric ganglia) compressing the celiac trunk, celiacomesenteric trunk compression by diaphragmatic crura and MAL, or combinations of the above mentioned entities. In this review we describe potential sources of compression of the celiac artery by regional structures and treatments of CACS in an effort to justify the relevance of CACS in modern medicine.

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confidence: 96%

Clinical anatomy of celiac artery compression syndrome: A review

et al. 2007

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“…Few cases of celiac trunk revascularization during PD have been reported and include prosthetic or autologous vein by-pass [9,10], reimplantation of the celiac trunk [2,11], and preservation of collateral pathways [12,13] or other vascular by-passes [14,15].…”

Section: Discussionmentioning

confidence: 99%

Pancreaticoduodenectomy with unusual artery reconstruction in a patient with celiac axis occlusion: report of a case

et al. 2010

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Celiac axis stenosis is a relatively common finding that may require major revascularization during pancreaticoduodenectomy. We present a patient that underwent pancreaticoduodenectomy for intraductal papillary mucinous neoplasm of the pancreatic head associated with celiac axis obstruction. To secure arterial blood flow to the upper abdominal organs, the superior posterior pancreaticoduodenal artery and the posterior-inferior pancreatic-duodenal artery were carefully preserved, and anastomosed. The postoperative course was complicated by a pseudoaneurysm of the splenic artery that was successfully treated with angiographic embolization through the vascular bypass. This may be a valid alternative procedure for revascularization of the common hepatic artery during pancreaticoduodenectomy in a patient with celiac axis stenosis.

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“…The MAL is the most common cause of CAS in Eastern countries (7), in contrast to Western countries where arteriosclerosis is the most common cause (9). The incidence of celiac artery stenosis is 7.6% (10) in the population undergoing PD. MAL compression is the major cause of stenosis in this group, which is detected in up to 5% of patients (11)(12)(13).…”

Section: Discussionmentioning

confidence: 99%