Distance from Left Renal Vein to Inferior Pancreaticoduodenal Artery: A Landmark for Identifying Inferior Pancreaticoduodenal Artery in Pancreatoduodenectomy

Abstract

Background/Aim: During pancreatoduodenectomy, early ligation of major afferent arteries to pancreatic head prior to dissection of the corresponding veins may reduce intraoperative bleeding. Inferior pancreaticoduodenal artery (IPDA), one of the major afferent arteries, is difficult to identify. We measured the distance from left renal vein to IPDA based on preoperative multi-detector row computed tomography (MDCT) images for use as a new landmark for IPDA. Methods: The distance between left renal vein and IPDA was measured in 417 patients using MDCT images. Results: IPDA was identified on MDCT images in 415 out of the 417 patients (99.5%). The root of IPDA was located on cranial side of the root of left renal vein in 88 among the 415 patients (21.2%), and the distance was expressed as negative in these cases. The distance was 6.09 ± 7.46 mm. The distance when IPDA formed a common vessel with first jejunal artery (8.03 ± 6.74 mm; 323 cases, 77.8%) was significantly longer than when IPDA branched directly from superior mesenteric artery (SMA; -0.81 ± 5.74 mm; 62 cases, 15.0%) or posterior and anterior IPDAs branched separately from SMA (-2.04 ± 5.36 mm; 30 cases, 7.2%). Conclusions: The distance between left renal vein and IPDA can serve as a landmark for IPDA identification.

The Branching Pattern of the Inferior Pancreaticoduodenal Artery in Patients with a Replaced Right Hepatic Artery

“…Focusing on IPDA identification, we also advocated distance from the left renal vein as a new landmark for identifying IPDA. 10 Variations in hepatic arterial anatomy are reported in 40-45 per cent of the population. 11,12 Although the right hepatic artery (RHA) normally arises from the proper hepatic artery (PHA), one of the most frequent variants is "replaced RHA (rRHA)," which is when RHA originates from arteries other than PHA, such as SMA, common hepatic artery (CHA), left gastric artery (LGA), or aorta.…”