The role of revascularization in celiac occlusion and pancreatoduodenectomy

Berney, Thierry; Prêtre, René; Chassot, Gilles; Morel, Philippe

doi:10.1016/s0002-9610(98)00195-0

Cited by 88 publications

(76 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The causes of CAS can be classified as extrinsic stenosis (MAL), intrinsic stenosis (arteriosclerosis) and various other causes, including congenital, neoplastic etc. (7,9). The MAL is the most common cause of CAS in Eastern countries (7), in contrast to Western countries where arteriosclerosis is the most common cause (9).…”

Section: Discussionmentioning

confidence: 99%

Problems with the Median Arcuate Ligament Should Be Recognized before Surgery; Its Importance in Pancreaticoduodenectomy

Başkan¹,

Özdenkaya²,

Erol³

et al. 2015

Balkan Med J

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Problems with the Median Arcuate Ligament Should Be Recognized before Surgery; Its Importance in Pancreaticoduodenectomy

Başkan¹,

Özdenkaya²,

Erol³

et al. 2015

Balkan Med J

View full text Add to dashboard Cite

“…Advances in preoperative imaging have allowed identification of arterial insufficiency prior to surgery. 5 Coeliac stenosis is present in 7.6% of patients undergoing pancreaticoduodenectomy, with the majority of cases attributable to MALS. 10,11 The first case reports of pancreaticoduodenectomy in the presence of MALS emerged in 1981; these were managed intraoperatively with either median arcuate ligament release or vascular reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5] It is usually asymptomatic owing to compensatory collateral supply via anastomotic connections between the inferior pancreaticoduodenal and gastroduodenal arteries (GDAs). If symptoms do occur, these most frequently consist of weight loss, post-prandial abdominal pain, nausea and vomiting or diarrhoea.…”

mentioning

confidence: 99%

Management of median arcuate ligament syndrome in patients who require pancreaticoduodenectomy

Whistance

Shah

Grist

et al. 2011

annals

View full text Add to dashboard Cite

Pancreaticoduodenectomy is the standard treatment for localised neoplasms of the pancreatic head. The operation can be performed safely in specialist units but good outcome is compromised if postoperative blood flow to the liver and biliary tree is inadequate. Coeliac artery occlusion with blood supply to the liver arising from the superior mesenteric artery via the gastroduodenal artery is difficult to recognise, especially intraoperatively. Recognition of absent hepatic artery pulsation after occlusion of the gastroduodenal artery opens a dilemma: should the resection be abandoned or should vascular reconstruction be undertaken, adding risk to an already complex procedure? We describe two cases with a resectable pancreatic endocrine tumour in which coeliac artery occlusion caused by median arcuate ligament compression was identified from cross-sectional imaging and reconstructions. We highlight two different strategies to correct the vascular insufficiency and allow safe pancreatic resection.

show abstract

“…Currently, this is performed mainly by anatomical measurement (X-ray angiography, CT or MRI 10 ) of the degree of CA stenosis and the diameter of the GDA, the main collateral pathway that can compensate for the decrease of flow due to the CA with retrograde flow from the superior mesenteric artery. 11 Nevertheless, these measurements only indirectly reflect the complex haemodynamics in the coeliac area: Doppler hepatic artery flow monitoring 12,13 or clamping trial of the GDA [14][15][16] are often necessary during the surgical procedure. 17 Thus, a simple and robust non-invasive tool would be of great interest to directly assess the effect of CA stenosis on the haemodynamics before surgery.…”

Section: Introductionmentioning

confidence: 99%

Phase-contrast MRI evaluation of haemodynamic changes induces by a coeliac axis stenosis in the gastroduodenal artery

Haquin

Sigovan

Mabrut

et al. 2017

BJR

View full text Add to dashboard Cite

Objective: To evaluate the correlation between the gastroduodenal artery (GDA) haemodynamic changes and the degree of coeliac axis (CA) stenosis using phasecontrast MRI. Methods: The study was institutional review board approved, and written informed consent was obtained from patients included prospectively. A two-dimensional phase-contrast MRI was performed in 23 patients scheduled for a potential complex supramesocolic surgery, in a plane perpendicular to the GDA, during inspiration and expiration. The peak and mean velocities (V p and V m ), mean flow rate (Q m ) and flow direction at inspiration and at expiration have been correlated with the degree of CA stenosis evaluated by CT. Results: 13 of 23 patients presented CA stenosis due to the median arcuate ligament (34-80% of stenosis), 4 of them had associated atheromatous calcifications. V p , V m and Q m of GDA presented a significant and linear relationship with the degree of CA stenosis, at inspiration as well as at expiration (r . 0.74, p , 0.001). Velocities and flow rates presented a different pattern depending on the degree of CA stenosis: ,34% (n 5 10), flow direction remained physiological with low velocities and flow rates; .60% of stenosis (n 5 5), a reverse flow direction with increased velocities and flow rates were observed; variable patterns between 34% and 60%. Conclusion: Phase-contrast MRI permits the evaluation of haemodynamic changes in GDA induced by CA stenosis, including median arcuate ligament compression, and could be of great interest in therapeutic decision making in supramesocolic surgery, such as liver transplantation or duodenopancreatectomy, by detecting haemodynamically significant stenoses. Advances in knowledge: Physiological phase-contrast MRI detects haemodynamically significant stenoses of the CA by evaluating haemodynamic parameters in the GDA. Physiological phase-contrast MRI demonstrates that flow in the GDA can be a direct marker of the real haemodynamic impact of a CA stenosis on the hepatic vascularization and could thus participate in the presurgical work-up of duodenopancreatectomy or hepatic graft, whereas existing pre-operative imaging are only morphological.

show abstract

The role of revascularization in celiac occlusion and pancreatoduodenectomy

Cited by 88 publications

References 13 publications

Problems with the Median Arcuate Ligament Should Be Recognized before Surgery; Its Importance in Pancreaticoduodenectomy

Problems with the Median Arcuate Ligament Should Be Recognized before Surgery; Its Importance in Pancreaticoduodenectomy

Management of median arcuate ligament syndrome in patients who require pancreaticoduodenectomy

Phase-contrast MRI evaluation of haemodynamic changes induces by a coeliac axis stenosis in the gastroduodenal artery

Contact Info

Product

Resources

About