Clinical significance of mesenteric arterial collateral circulation in patients with celiac artery compression syndrome

Petersen, André S. van; Gerrits, Dick; Palen, Job van der; Zeebregts, Clark J.; Geelkerken, Robert H.; Bruno, Marco J.; Dijk, Louisa J. van; Moelker, Adriaan; Peppelenbosch, Maikel P.; Verhagen, Hence J.M.; Blauw, Juliëtte T.M.; Kolkman, Jeroen J.; Bakker, Olaf J.

doi:10.1016/j.jvs.2016.11.052

Cited by 27 publications

(25 citation statements)

References 31 publications

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“…Due to the severe stenosis, it failed to function. CAS results in the development of major collateral pathways (GDA or DPA) that arise from the SMA, resulting in the feeding of the CHA branches through retrograde flow via the GDA or the arc of Buhler [8,9,39,40]. However, in patients with CAS who have developed a collateral pathway through the GDA that is sacrificed during pancreaticoduodenectomy, we must consider how to preserve the arterial flow of the liver.…”

Section: Discussionmentioning

confidence: 99%

Pancreaticoduodenectomy with reconstructing blood flow of the gastric conduit after esophagectomy with concomitant celiac axis stenosis: a case report

et al. 2020

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Background Pancreaticoduodenectomy after esophageal resection is technically difficult, because blood flow of the gastric conduit should be preserved. Celiac axis stenosis (CAS) is also a problem for pancreaticoduodenectomy, because arterial blood supply for the liver comes mainly through the collateral route from the superior mesenteric artery (SMA) via the gastroduodenal artery (GDA). Herein, we report the case of a patient with pancreatic head cancer who underwent a pancreaticoduodenectomy after esophagectomy with concomitant CAS. Case presentation A 76-year-old man with pancreatic head cancer was referred to our department. He had a history of esophagectomy with retrosternal gastric conduit reconstruction for esophageal cancer. Computed tomography showed severe CAS and a dilated collateral route between the SMA and the splenic artery (SPA). We prepared several surgical options depending on the intraoperative findings, and performed radical pancreaticoduodenectomy with concomitant resection of the distal gastric conduit. The right gastroepiploic artery (RGEA) of the remnant gastric conduit was fed from the left middle colic artery (MCA) with microvascular anastomosis. Despite CAS, when the GDA was dissected and clamped, good blood flow was confirmed, and the proper hepatic artery did not require reconstruction. The patient was discharged on postoperative day 90. Conclusions We successfully performed radical pancreaticoduodenectomy after esophagectomy with concomitant CAS, having prepared multiple surgical options depending upon the intraoperative findings.

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Section: Discussionmentioning

confidence: 99%

Pancreaticoduodenectomy with reconstructing blood flow of the gastric conduit after esophagectomy with concomitant celiac axis stenosis: a case report

et al. 2020

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“…Severe stenosis or obstruction of the CA often induces the formation of collateral arterial pathways from the SMA system to the CA system to compensate the decrease of splanchnic arterial flow of the upper abdomen. The main collateral pathway is reported to be the GDA or DPA in most cases, whereas various arteries, such as the DPA, jejunal artery, omental artery, left gastric artery, arc of Buhlar, and Riolan or Drummond artery can be a collateral pathway [1,5]. Song et al described a total of 181 anastomoses in 94 CAS patients, including 89 pancreaticoduodenal arcades and 71 dorsal pancreatic arcades [2].…”

Section: Discussionmentioning

confidence: 99%

“…However, CAS is often asymptomatic due to the formation of collateral blood flow from surrounding arteries [2]. In many cases, the gastroduodenal artery (GDA) is a main collateral pathway from the superior mesenteric artery (SMA) to the CA system through common hepatic artery (CHA) [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Arterial communication around the pancreatic tail enabled division of the gastroduodenal artery during pancreaticoduodenectomy in patient with complete celiac artery occlusion: a case report

et al. 2020

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Background: Stenosis or obstruction of the celiac artery (CA) is known as celiac artery stenosis (CAS) and is usually accompanied by the formation of arterial anastomosis between the superior mesenteric artery (SMA) system and the CA system. Arterial bypass is mainly achieved through the gastroduodenal artery (GDA); therefore, the division of the GDA during pancreaticoduodenectomy (PD) could pose a problem in patients with CAS. Case presentation: We reported a case of PD presenting complete occlusion of the CA, in which perfusion to organs in the CA system was maintained via peri-pancreatic arterial communication. There were complicated arterial anastomoses around the pancreas, which were clearly visualized on a three-dimensional reconstruction of the arterial system using multi-detector computed tomography. Among these complicated anastomoses, one welldeveloped anastomosis between the SMA and the splenic artery through the dorsal pancreatic artery (DPA) was identified. The DPA was considered to work as a potential collateral pathway from the SMA to organs in the CA system after division of the GDA. During surgery, Doppler ultrasonography detected hepatopetal arterial flow even after the GDA clamping; therefore, we performed typical PD with division of the GDA. The postoperative course of the patient was uneventful, and there was no sign of ischemic complications in the CA system organs including the liver, stomach or spleen. Conclusions: Three-dimensional reconstruction of the arterial system using multi-detector computed tomography and the intraoperative GDA clamping test were useful to determine whether it was possible to divide the GDA in PD, in the case of CAS.

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“…[5] Despite that, very few of these patients displayed clinical symptoms due to insignificant hemodynamic stenosis or ample perfusion via anastomotic circulation by other mesenteric vessels. [6] The incidence of Dunbar syndrome is estimated to be 2 per 100,000 population, and it typically manifests in women between the ages of 40 and 60 with a thin build. [2] When present, it most frequently involves postprandial abdominal pain (94%), weight loss ( 50%), and an abdominal bruit (35%).…”

Section: Introductionmentioning

confidence: 99%

Dunbar syndrome as a cause of chronic abdominal pain in a 24-year-old female

Koenig

Yednock

2020

CRIM

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External compression of the celiac artery by the median arcuate ligament is referred to as Dunbar syndrome, which is an eponym for celiac axis syndrome or median arcuate ligament syndrome. It is correlated with the archetypal triad of postprandial abdominal pain, weight loss of greater than 20 pounds, and an abdominal bruit on auscultation. This is often accompanied by epigastric tenderness, vomiting, and nausea. Given its lack of symptomatic specificity, Dunbar syndrome is a diagnosis of exclusion for unexplained episodic abdominal discomfort. Here, we present a unique case of a 24-year-old woman who experienced several months of chronic abdominal distress and an extensive workup prior to being diagnosed with Dunbar syndrome. The diagnosis was made via cross-sectional abdominal imaging and duplex ultrasound with respiratory maneuvers, which showed downward displacement of the celiac trunk, post-stenotic dilatation, and increased flow velocity on expiration. She underwent successful laparoscopic division of the median arcuate ligament which greatly alleviated her pain.

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Clinical significance of mesenteric arterial collateral circulation in patients with celiac artery compression syndrome

Cited by 27 publications

References 31 publications

Pancreaticoduodenectomy with reconstructing blood flow of the gastric conduit after esophagectomy with concomitant celiac axis stenosis: a case report

Pancreaticoduodenectomy with reconstructing blood flow of the gastric conduit after esophagectomy with concomitant celiac axis stenosis: a case report

Arterial communication around the pancreatic tail enabled division of the gastroduodenal artery during pancreaticoduodenectomy in patient with complete celiac artery occlusion: a case report

Dunbar syndrome as a cause of chronic abdominal pain in a 24-year-old female

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