Morphological analysis of the branches of the dorsal pancreatic artery and their clinical significance

Tsutsumi, Masahiro; Arakawa, Takamitsu; Terashima, Toshio; Aizawa, Yukio; Kageyama, Ikuo; Kumaki, Katsuji; Miki, Akinori

doi:10.1002/ca.22331

Cited by 16 publications

(8 citation statements)

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“…In our study, the transverse pancreatic artery, the only vessel in the watershed area, originated from the dorsal pancreatic artery in 26.9% (as its left branch of division), from the superior mesenteric artery in 19.2%, from the splenic artery in 7.7%, from the PDJ trunk in 7.7%, and from the gastroduodenal artery, great pancreatic and PIPD in 3.8%. These data agree with the dissection and imaging studies of Bertelli et al () and Tsutsumi et al (), which reported great variability in the origins of the dorsal and transverse pancreatic arteries. This variability can explain the different patterns of vascularization at the level of the watershed area.…”

Section: Discussionsupporting

confidence: 92%

Anatomo‐radiological patterns of pancreatic vascularization, with surgical implications: Clinical and anatomical study

et al. 2017

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The pancreas receives multiple arterial sources that should be considered in patients undergoing pancreatic surgery. The aim of this study is to describe pancreatic vascularization and to explore the anatomical basis of postoperative complications. Ten specimens from unembalmed cadavers, including the retroperitoneal vessels and organs and spleen, were injected with acrylic resins to obtain vascular casts. Thirty computed tomography angiographies (CTA) of subjects with no pancreatic pathology (mean age 70.9 years) were also analyzed. A paucivascular area at the neck of the pancreas was apparent in all vascular casts. At CTA: (1) the transverse pancreatic artery, the only artery running from the cervicocephalic to the somatocaudal segment, was visible in 76.9% of cases; (2) the splenic artery was suprapancreatic in 66.7% and intrapancreatic with a tortuous course in 33.3%; (3) the posterior superior pancreaticoduodenal artery was visible in 100% of cases, the anterior superior pancreatico-duodenal artery in 92.6%, the anterior inferior pancreaticoduodenal artery in 73.1%, the posterior inferior pancreaticoduodenal artery in 86.4%, the dorsal pancreatic artery in 65.4%, the great pancreatic artery in 73.1%, and the pancreatic arteries to the body and caudal pancreatic arteries in 96.2%. Our study demonstrated great individual variability of the pancreatic vasculature, which can be explored by CTA and could be relevant to surgical procedures. Clin. Anat. 30:614-624, 2017. © 2017 Wiley Periodicals, Inc.

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Section: Discussionsupporting

confidence: 92%

Anatomo‐radiological patterns of pancreatic vascularization, with surgical implications: Clinical and anatomical study

et al. 2017

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“…In this study, the DPA was observed in 91% of cases and provided a constant branch to the head of the pancreas as described previously [ 7 ]. This branch runs posterior to the SMV or PV to reach the retroportal portion of the pancreatic head, running across the base of the mesopancreatic triangle, (Figure 4 ).…”

Section: Discussionmentioning

confidence: 62%

Surgical Anatomy of the Mesopancreas in Obese Patients: A Retrospective Study

Aldouri¹,

Zia²,

Agouba³

et al. 2023

Cureus

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Introduction The mesopancreas is described as a triangle formed by the superior mesenteric vein, celiac axis (CA), and superior mesenteric artery (SMA). It is the most likely site of residual cancer and local recurrence after surgical resection, making it the key site of the current radical resection of pancreatic head cancer. The surgical anatomy of the mesopancreas triangle has not been studied in detail. Furthermore, to the best of our knowledge, no information is available on the impact of obesity on the anatomy of the mesopancreas triangle. Methods Between January 2016 and August 2016, 200 consecutive triple-phase computed tomography scans of the abdomen were performed and included in this retrospective study aiming to define the anatomical relation of the left renal vein (LRV) to the root of the SMA and focusing on the relevance of the LRV as a landmark to guidance for the dissection of the mesopancreas. Furthermore, by studying six surgically relevant anatomical parameters namely the thickness of the areolar tissue separating the LRV from the root of the SMA, IVC from the root of the SMA, the left adrenal vein (LAV) from the root of the SMA, splenic vein from the aorta, and CA from the SMA at two levels, we investigated the impact of obesity on the mesopancreas anatomy. Results The mean distance from the upper border of the LRV to the root of the SMA (LRV-SMA distance) was 2.3 ± 5.4 mm. There was no correlation between this distance and patient’s age ( r = -0.02), height ( r = -0.07), BMI ( r = -0.01), visceral fat area ( r = -0.04), or abdominal circumference ( r = -0.02). There was no correlation between the distance from the IVC to the root of the SMA, and patient’s age ( r = 0.01), height ( r = 0.11), BMI ( r = 0.15), or abdominal circumference ( r = 0.00). However, there was a negligible correlation between the IVC-SMA distance and patient’s visceral fat area ( r = 0.15, p = 0.036). Conclusion In the current study, the LRV was reliably identified in more than 99% of the studied patients, and in 96% of patients, the LRV crosses anterior to the aorta at the level of the second lumbar vertebra, making it easily accessible following mobilization of the duodenum and the head of the pancreas. The relationship between the LRV and SMA remains unchanged following Kocherization. Most importantly, we demonstrated that the LRV-SMA distance does not correlate with patient’s age, height, BMI, visceral fat area, or abdominal circumference. This makes the LRV a reliable landmark in both obese and non-obese patients.

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“…4,12,13 Although we could not confirm all of these variations in the present study, the celiac trunk-derived branches probably run behind the pancreas and anastomose to the marginal artery in the left half of the transverse mesocolon, as in type P. Such branches running behind the pancreas probably divide into 1 or some branches to the pancreas and should be named the dorsal pancreatic artery. 19,20 Because Tandler 21 hypothesized that there is an anastomosis between the celiac trunk and SMA during early development, it has traditionally been believed that the celiac trunk-derived artery supplying the colon is an anastomosis between the celiac trunk and IMA. 11 However, in the present study, we showed that such branches were anastomosed to the marginal artery in the transverse colon and not to the LCA, suggesting that the celiac trunk-derived pancreatic artery just supplies the colon.…”

Section: Discussionmentioning

confidence: 99%

Two Types of Variational Artery’s Course from the Superior Mesenteric Artery to Supply the Splenic Flexure: Gross Anatomical Study

Okazaki

Omotehara

Kawata

et al. 2023

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Complete mesocolic excision with central vascular ligation is a standard method for colon cancer. However, there is no consensus on its procedure, especially for cancer in the splenic flexure of the transverse colon. This is because various types of variational arteries are distributed to the region, and their running course below and near the pancreas leads to difficulty in ligating the artery. OBJECTIVE: This study aimed to clarify the arterial distribution to the SF of the transverse colon using cadavers. DESIGN: The arteries in the transverse mesocolon distributed to the colon were dissected in cadavers, and their route was quantitatively visualized using drawing software. SETTINGS: This study was conducted at the Department of Anatomy, Tokyo Medical University. PATIENTS: Sixty cadavers donated to Tokyo Medical University in 2017–2021 were used. MAIN OUTCOME MEASURES: The arterial courses to the splenic flexure of the transverse colon in the mesocolon and their patterns were evaluated. RESULTS: We found 34 variational arteries distributed to the splenic flexure of the transverse colon. Most originated from the superior mesenteric artery and middle colic artery, with their typical course below the pancreas. We identified another arterial course, crossing the mesocolon away from the pancreas toward the splenic flexure of the transverse colon. Furthermore, the origin of these arteries was not behind the pancreas and can be found in the caudal region of the pancreas. LIMITATIONS: We cannot discuss how the arteries within the transverse mesocolon are observed by computed tomography examination. CONCLUSIONS: This study showed two types of arterial courses (below the pancreas and within the mesocolon) toward the splenic flexure of the transverse colon for the first time. In the latter case, the complete mesocolic excision with central vascular ligation is likely performed more easily than in the former.

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Morphological analysis of the branches of the dorsal pancreatic artery and their clinical significance

Cited by 16 publications

References 16 publications

Anatomo‐radiological patterns of pancreatic vascularization, with surgical implications: Clinical and anatomical study

Anatomo‐radiological patterns of pancreatic vascularization, with surgical implications: Clinical and anatomical study

Surgical Anatomy of the Mesopancreas in Obese Patients: A Retrospective Study

Two Types of Variational Artery’s Course from the Superior Mesenteric Artery to Supply the Splenic Flexure: Gross Anatomical Study

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