Replaced gastroduodenal artery: Added benefit of the “artery first” approach during pancreaticoduodenectomy—A case report

Younan, George; Chimukangara, Munyaradzi; Tsai, Susan; Evans, Douglas B.; Christians, Kathleen K.

doi:10.1016/j.ijscr.2016.04.014

Cited by 10 publications

(10 citation statements)

References 19 publications

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“…An entirely replaced LHA on a GDA replaced to the SMA is described in 1 case report by Younan et al, however the patient described here is of added interest due to the incongruity with the previously published anatomical model described above (Younan et al 2016). An entire LHA arising from the GDA conforms with Song’s anatomical model.…”

Section: Discussionmentioning

confidence: 69%

Replaced gastroduodenal artery with continuation as accessory left hepatic artery: a rare anatomical variant

2018

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BackgroundPresented here is a rare case of a gastroduodenal artery (GDA) replaced to the superior mesenteric artery with continuation into an accessory left hepatic artery. To the authors’ knowledge, this rare anomaly is not described previously. Replaced GDA is reported, however without continuation into an accessory LHA.Case presentationA 74-year-old male with recurrent peptic ulcer disease presented with acute onset melena. This anomaly was discovered during abdominal angiography performed for treatment of a hemorrhagic duodenal ulcer. Initial celiac and common hepatic artery (CHA) subselection and angiography demonstrated no branch vessels. Angiography via the superior mesenteric artery demonstrated free extravasation into the duodenum and distal perfusion of the left hepatic lobe.ConclusionsThis is a rare variant of hepatic arterial anatomy. Importantly, this variant challenges a previously described anatomical model that attempts to explain observed CHA variation.

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Section: Discussionmentioning

confidence: 69%

Replaced gastroduodenal artery with continuation as accessory left hepatic artery: a rare anatomical variant

2018

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“…In a meta-analysis of CA variations which included 12,000 cases from 36 studies, there was no mention of a replaced GDA (rGDA) [2,7]. Many other studies have identified frequency of variations in origin of rGDA, summarised in Table 1 [14][15][16][17][18][19][20][21][22][23][24][25][26]. The various sites of origin of rGDA are shown in Figure 1.…”

Section: Origin Of Gdamentioning

confidence: 99%

“…Below D1, GDA travels between duodenum and pancreas in the duodenal gutter of Wiart . Studies have shown that a rGDA originating from SMA arises below the neck of the pancreas and runs anterior to the neck of pancreas, whereas a rGDA originating from a rCHA from SMA arises below the neck of pancreas and courses posteriorly or sometimes even through the pancreatic parenchyma and very rarely anterior to the pancreas .…”

Section: Course and Relations Of Gdamentioning

confidence: 99%

“…GDA identification and ligation is one of the key steps during pancreaticoduodenectomy (PD). This begins with accurate preoperative identification of anatomical course and variations of GDA . It is important to rule out CAS at this stage on imaging or endoscopic ultrasound (EUS) if it is being performed.…”

Section: Pancreatic Surgerymentioning

confidence: 99%

“…This approach also helps in identification of rGDA arising from IPDA which is a branch of SMA. In these cases, IPDA may need ligation beyond the origin of GDA .…”

Section: Pancreatic Surgerymentioning

confidence: 99%

See 2 more Smart Citations

Gastroduodenal artery: single key for many locks

Desai

Pande

2019

J Hepato Biliary Pancreat

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Gastroduodenal artery (GDA) commonly arises from common hepatic artery, a branch of celiac axis. It holds a unique anatomical position that connects the foregut and midgut due to its intimate communications with foregut and midgut arterial supply. Its numerous anatomical variations have a significant impact on planning and performance of hepatopancreaticobiliary (HPB) surgery. Its close relation to the first part of duodenum, common bile duct and head of pancreas makes it susceptible for inadvertent bleeding during or after surgery, or due to various HPB pathologies. Also, a large number of vascular interventions rely on GDA and its branches. Careful preoperative planning is the key and a detailed knowledge and awareness of its variant anatomy is of paramount importance, be it liver resections, liver transplant, biliary and pancreatic resections and pancreatic transplant or transarterial procedures involving these arteries. GDA can also be a cause of gastrointestinal hemorrhage due to true or pseudoaneurysms and anatomy has significant implications on its management. The article provides a succinct review on relevance of GDA anatomy and variations and highlights that preoperative planning and intraoperative awareness of variations is the key to performance of safe HPB surgery and interventions.

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Cavernous Transformation of the Portal Vein Requiring Temporary Mesocaval Shunt and Internal Jugular Vein Interposition Graft

Younan

Evans

Christians

2017

Case-Based Lessons in the Management of Complex Hepato-Pancreato-Biliary Surgery

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Replaced gastroduodenal artery: Added benefit of the “artery first” approach during pancreaticoduodenectomy—A case report

Cited by 10 publications

References 19 publications

Replaced gastroduodenal artery with continuation as accessory left hepatic artery: a rare anatomical variant

Replaced gastroduodenal artery with continuation as accessory left hepatic artery: a rare anatomical variant

Gastroduodenal artery: single key for many locks

Cavernous Transformation of the Portal Vein Requiring Temporary Mesocaval Shunt and Internal Jugular Vein Interposition Graft

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