Classification of the celiac axis stenosis owing to median arcuate ligament compression, based on severity of the stenosis with subsequent proposals for management during pancreatoduodenectomy

Sugae, Takashi; Fujii, Tsutomu; Kodera, Yasuhiro; Kanzaki, Akiyuki; Yamamura, Kazuo; Yamada, Suguru; Sugimoto, Hiroyuki; Nomoto, Shuji; Takeda, Shin; Nakao, Akimasa

doi:10.1016/j.surg.2011.08.012

Cited by 74 publications

(79 citation statements)

References 18 publications

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“…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: 87%

Problems with the Median Arcuate Ligament Should Be Recognized before Surgery; Its Importance in Pancreaticoduodenectomy

Başkan¹,

Özdenkaya²,

Erol³

et al. 2015

Balkan Med J

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Section: Discussionmentioning

confidence: 87%

Problems with the Median Arcuate Ligament Should Be Recognized before Surgery; Its Importance in Pancreaticoduodenectomy

Başkan¹,

Özdenkaya²,

Erol³

et al. 2015

Balkan Med J

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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%

“…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] . Sugae et al [27] proposed a morphological grading of celiac axis stenosis (A, B and C) by MAL compression according to stenosis grade and duration, distance from the aorta, and collateral pathways.…”

Section: Hepatic Artery Anatomical Variationsmentioning

confidence: 99%

“…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] . Sugae et al [27] proposed a morphological grading of celiac axis stenosis (A, B and C) by MAL compression according to stenosis grade and duration, distance from the aorta, and collateral pathways.…”

Section: Hepatic Artery Anatomical Variationsmentioning

confidence: 99%

“…To maintain correct blood supply after PD in patients with CAS, a detailed preoperative assessment is essential [23,26,27] . The best method for defining CAS and its etiology is multidetector CT [24,27] .…”

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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Treatment strategies for unruptured pancreaticoduodenal artery aneurysms associated with celiac artery occlusion

Koyama

Shimizu

Noguchi

et al. 2022

Annals of Gastroent Surgery

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Celiac artery (CA) occlusion or stenosis is identified in up to almost half of all patients undergoing abdominal angiography, and the resulting increased collateral blood flow from the superior mesenteric artery to the pancreaticoduodenal artery (PDA) may cause PDA aneurysms (PDAAs). PDAAs are rare but could be fatal if they rupture. However, treatment of the PDAA could block this important collateral blood flow pathway, leading to ischemic organ damage. Treatment of such aneurysms is therefore difficult, especially in patients with multiple PDAAs. Successful treatment of PDAAs requires establishing blood flow in the CA region and selecting which aneurysm(s) to treat. We present four patients who underwent surgery for unruptured PDAAs caused by CA obstruction. Blood flow in the CA region was established by bypassing the splenic artery and by anastomosing it either directly to the left renal artery (n = 1) or to the abdominal aorta using a graft (saphenous vein: n = 1; artificial vessel: n = 2). Three patients had multiple PDAAs: all PDAAs were treated in one patient with PDAAs of similar size and shape, but only the largest PDAA with the highest risk of rupture was treated in the other two patients to simplify the procedure. The median observation period was 19.5 months (range: 11‐28 months), and all patients were alive without recurrence at the time of writing. Surgical treatment including splenic artery bypass may thus be a viable option for treating patients with unruptured PDAAs.

show abstract

Classification of the celiac axis stenosis owing to median arcuate ligament compression, based on severity of the stenosis with subsequent proposals for management during pancreatoduodenectomy

Cited by 74 publications

References 18 publications

Problems with the Median Arcuate Ligament Should Be Recognized before Surgery; Its Importance in Pancreaticoduodenectomy

Problems with the Median Arcuate Ligament Should Be Recognized before Surgery; Its Importance in Pancreaticoduodenectomy

Tricks and tips in pancreatoduodenectomy

Treatment strategies for unruptured pancreaticoduodenal artery aneurysms associated with celiac artery occlusion

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