Impact of Vascular Anomalies on Pancreatoduodenectomy Procedure

Mansour, Subhi; Damouny, Mira; Obeid, Miriam; Farah, A; Halloun, Kenan; Marjiyeh, Rozan; Ghalia, Jawad; Kluger, Yoram

doi:10.14740/jocmr4455

Cited by 10 publications

(8 citation statements)

References 30 publications

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“…These HA derived from SMA usually runs posteriorly and through the pancreatic nerve plexus, which requires special attention to preserve during PD. [ 2 , 21 ] Contrarily, variation of GDA is scarce. According to Lipshutz [ 12 ] report, GDA originates from CHA in 92% of the cases.…”

Section: Discussionmentioning

confidence: 99%

“…The replaced right HA or the replaced CHA was in around 10% to 12% or 1% to 3%, respectively. These HA derived from SMA usually runs posteriorly and through the pancreatic nerve plexus, which requires special attention to preserve during PD [2,21] . Contrarily, variation of GDA is scarce.…”

Section: Discussionmentioning

confidence: 99%

“…[ 1 ] Hence, anatomical knowledge is essential before surgery. [ 2 ] Identifying arterial abnormalities is the key to reduce ischemic or hemorrhagic morbidity and mortality. [ 3 ] Multi detector-row computed tomography (MDCT) and CT angiography (CTA) enable us to understand the anatomical structure of blood vessels.…”

Section: Introductionmentioning

confidence: 99%

“…Pancreaticoduodenectomy (PD) is a technically demanding procedure with high rates of morbidity and mortality [1] . Hence, anatomical knowledge is essential before surgery [2] . Identifying arterial abnormalities is the key to reduce ischemic or hemorrhagic morbidity and mortality [3] .…”

Section: Introductionmentioning

confidence: 99%

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Pancreaticoduodenectomy preserving aberrant gastroduodenal artery utilized in a previous coronary artery bypass grafting

et al. 2021

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Rationale: Pancreaticoduodenectomy (PD) is a technically demanding procedure with high rates of morbidity and mortality. Therefore, preoperative evaluation of anatomy is indispensable. Multi-detector row computed tomography (CT) enables us to precisely understand arterial anatomy. It is a well-known fact that anatomical variants are often present in the hepatic artery (HA) but rarely in the gastroduodenal artery (GDA). We present the case of a patient with ampullary cancer with a rare anatomical anomaly, “replaced GDA (rGDA) ” arising from the superior mesenteric artery, along with a history of coronary artery bypass grafting (CABG) using right gastroepiploic artery (RGEA). Patient concerns: A 69-year-old male patient was referred to our department for further investigation of elevated hepatobiliary enzymes. He presented with no symptoms besides intermittent fever of 38°C. He had an operative history of CABG using the RGEA. Diagnosis: Abdominal CT and esophagogastroduodenoscopy showed an ampullary tumor and biopsy specimen from the lesion revealed adenocarcinoma. CT angiography revealed the rGDA instead of a normal common HA. Intervention: We performed a safe PD, preserving the rGDA and the RGEA to maintain hepatic and cardiac perfusion. Outcomes: Owing to the presence of a refractory pancreatic fistula, the length-of-hospital stay was extended, and he was discharged on postoperative day 72 without vascular complications. At present, the patient is in good physical condition and does not present with cardiovascular complications as well as tumor recurrence at 6 months after surgery. Lessons: This is possibly the first case of a patient who underwent PD and has a proper HA following a GDA arising from a superior mesenteric artery (rGDA) and has a previous operative history of CABG using the gastroepiploic artery. The coexistence of the history of cardiovascular surgery made PD for this patient considerably more challenging. In the case of a rare anatomical anomaly, a coronary artery bypass via the RGEA should not be considered as an obstacle when R0 resection is achievable.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pancreaticoduodenectomy preserving aberrant gastroduodenal artery utilized in a previous coronary artery bypass grafting

et al. 2021

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“…Careful and thorough preoperative assessment of radiology is essential to have a roadmap to avoid injuries to such anomalous structures during surgery [1][2][3][4][5][6][7]. Preoperative knowledge of this anomaly allowed safe dissection of the anomalous SMV off the uncinate process from behind early in the course of surgery.…”

Section: Case Detailsmentioning

confidence: 99%

‘Retro-uncinate Superior Mesenteric Vein’ – first report of a rare congenital anomaly and possible embryological explanation

Patel

Yelamanchi

Patkar

et al. 2023

Preprint

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We evaluated a 61-year-old female for a periampullary cancer. The preoperative contrast enhanced CT scan demonstrated an abnormal course of superior mesenteric vein (SMV). The vein was absent from its normal location in the groove behind neck of the pancreas and anterior to the superior mesenteric artery. It was found to be coursing anomalously, posterior to the uncinate process of pancreas and on the right of superior mesenteric artery. This is probably the first report of this anomaly. We had to coin the term ‘retro- uncinate SMV’ to describe this anatomical variation. Rest of the porta structures and pancreas were found to be anatomically normal in this patient. This is a rare anomaly, probably does not have a pathological consequence and remained unreported. Congenital variations in porta structures are relatively common. Careful and thorough preoperative assessment of radiology is essential to have a roadmap to avoid injuries to such anomalous structures during surgery. Preoperative identification of this anomaly resulted in a safe pancreaticoduodenectomy in this patient. Development of portal venous system and pancreas are closely related due to their anatomical proximity. Normally, the left part of ventral pancreatic anlage regresses and right part rotates posterior to the developing SMV. Malrotation of this right ventral pancreatic anlage anterior to the developing SMV or Regression of right ventral pancreatic anlage and persistence and development of left ventral pancreatic analge anterior to the developing SMV is the only logical explanation for development of this anomaly.

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Preoperative Identification and Outcomes of Vascular Variants on Surgery for Chronic Pancreatitis

Salamah,

Patel,

Chen

et al. 2024

Journal of Surgical Research

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Impact of Vascular Anomalies on Pancreatoduodenectomy Procedure

Cited by 10 publications

References 30 publications

Pancreaticoduodenectomy preserving aberrant gastroduodenal artery utilized in a previous coronary artery bypass grafting

Pancreaticoduodenectomy preserving aberrant gastroduodenal artery utilized in a previous coronary artery bypass grafting

‘Retro-uncinate Superior Mesenteric Vein’ – first report of a rare congenital anomaly and possible embryological explanation

Preoperative Identification and Outcomes of Vascular Variants on Surgery for Chronic Pancreatitis

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