Radiological–Surgical Methods to Identify Celiac–Mesenteric Anomalies of the Hepatic Artery Before Duodenopancreatectomy

Valverde, David Padilla; Campos, Pedro Villarejo; Liñán, José Villanueva; Sánchez, Pablo Menéndez; Cintas, Teófilo Cubo; Fernández, Jesús Martín

doi:10.1016/j.cireng.2012.04.002

Cited by 3 publications

(6 citation statements)

References 13 publications

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“…The most important HAAV that the surgeon must bear in mind during PD are accessory RHA and displaced or accessory CHA, both arising from the SMA [23] . Displaced or accessory RHA arising from the SMA (10%-21%) is the variation that is most often identified during PD [6,[20][21][22][23] . This vessel passes lateral to and behind the PV and can be felt by palpation, but it may also pass behind or through the pancreas [6,22,23] .…”

Section: Extended Lymphadenectomy For Pancreatic Head Adenocarcinomamentioning

confidence: 99%

“…Rates of anatomical variations in the hepatic arterial system may be as high as 45% [20,21] . A thorough knowledge of HA anatomy is essential; in the presence of HA anatomical variations (HAAV), accidental ligation may occur during PD, provoking hepatic necrosis, ischemic biliary injury or an anastomotic fistula [6,[20][21][22][23][24] .…”

Section: Hepatic Artery Anatomical Variationsmentioning

confidence: 99%

“…However, in the standard approach, dissection of an HAAV coming from the SMA is usually performed late, when bleeding reduces its exposure [6] . When SMA dissection is performed first, the exposure of the HAAV is better, particularly the RHA or a CHA originating from the SMA or aorta [6,13,21] . In vessels that lie within the head of the pancreas there are several options.…”

Section: Extended Lymphadenectomy For Pancreatic Head Adenocarcinomamentioning

confidence: 99%

“…A thorough knowledge of HA anatomy is essential; in the presence of HA anatomical variations (HAAV), accidental ligation may occur during PD, provoking hepatic necrosis, ischemic biliary injury or an anastomotic fistula [6,[20][21][22][23][24] . Preoperative assessment of peripancreatic vascular patterns using imaging methods is crucial for surgeons [22] .…”

Section: Hepatic Artery Anatomical Variationsmentioning

confidence: 99%

“…Preoperative assessment of peripancreatic vascular patterns using imaging methods is crucial for surgeons [22] . Multidetector CT is the method of choice, and multidimensional reconstruction may be very useful [6,[21][22][23]25] . Angiography is no longer needed [20] .…”

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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Section: Extended Lymphadenectomy For Pancreatic Head Adenocarcinomamentioning

confidence: 99%

Section: Hepatic Artery Anatomical Variationsmentioning

confidence: 99%

Section: Extended Lymphadenectomy For Pancreatic Head Adenocarcinomamentioning

confidence: 99%

Section: Hepatic Artery Anatomical Variationsmentioning

confidence: 99%

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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Aberrant hepatic arteries running through pancreatic parenchyma encountered during pancreatoduodenectomy

Wang

Xu²,

Sun³

et al. 2016

Medicine

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Anatomical variations of the hepatic artery: a closer view of rare unclassified variants

et al. 2022

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Background: Defining the hepatic artery anatomy is of great importance for both surgeons and radiologists. Michel classification was designed to classify hepatic artery variations. Nevertheless, there are variations that do not fit into this classification. In this study, we aim to define the incidence of all variations in a healthy liver donor by reviewing their CT scan with special emphasis on variations that do not fit in any of the Michel classes. Materials and methods: A retrospective analysis of CT scan of donors and potential liver donors who were evaluated by triphasic CT scan. The CT scans were reviewed independently by a radiologist and two transplant surgeons. Cases that did not fit in any of the Michel classes were classified as class 0. Results: Out of 241 donors, 210 were classified within the Michel classification, of which 60.9 % were class I and 9.1% class II. Thirty-one donors (12.9%) classified as class 0. Of which, nine, three, two and three had replaced right hepatic artery from pancreaticoduodenal artery, gastroduodenal artery, aorta and celiac artery, respectively. Two and 6 donors had accessory right hepatic artery from pancreaticoduodenal artery and gastroduodenal artery respectively. Segment 4 artery originated from left and right hepatic artery in 56.8% and 31.9%, respectively. Conclusions: A great caution should be taken when evaluating the hepatic artery anatomy, clinicians should anticipate and be familiar with the rare unclassified variations of the hepatic artery.

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Radiological–Surgical Methods to Identify Celiac–Mesenteric Anomalies of the Hepatic Artery Before Duodenopancreatectomy

Cited by 3 publications

References 13 publications

Tricks and tips in pancreatoduodenectomy

Tricks and tips in pancreatoduodenectomy

Aberrant hepatic arteries running through pancreatic parenchyma encountered during pancreatoduodenectomy

Anatomical variations of the hepatic artery: a closer view of rare unclassified variants

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