Vascular anatomy of the pancreaticoduodenal region: A review

Abstract

Vascular anatomy of the pancreaticoduodenal region has been the subject of numerous studies. However, several essential areas of confusion remain in interpretation of the vascular configuration. We note and discuss three key points in relation to this confusion: (1) a missing vascular arcade, (2) a rearrangement of the arcade by collateral and/or transverse vessels, and (3) a solitary vessel without an accompanying comites vein or artery. In addition, we consider that different interpretations as well as varying reported incidences depend on different "thresholds" when observations are made. Consideration of new aspects of vascular anatomy of the pancreaticoduodenal region is required for further improvement of surgical procedures. In terms of the selection of lymph node resection procedure, we discuss mainly the inferior arterial origin. Special attention should be paid to the ligation of inferior arteries because of the high incidence of the common trunk formation of the upper jejunal and inferior pancreaticoduodenal arteries. With regard to duodenum-preserving pancreatic head resection for benign tumors, our observations are introduced in view of either arterial or venous configuration. First, a communicating artery between the anterior and posterior arterial arcades is noted because of its possible critical role in blood supply to the papilla of Vater. Second, a venous drainage route from the duodenum to the retroperitoneal space in "normal" specimens is described.

Variations in Superior Pancreaticoduodenal Artery -A case report

“…During pancreaticoduodenectomies or lymph node resection procedures, ligation of IPDA also requires special attention, because of high incidence of common trunk formation of the first jejuna and IPDA 6 . The present study emphasizes the uncommon variations in the pancreaticoduodenal artery as it was arising from the hepatic artery, so it is a rare case because as per the previous investigators only 2.7% of the cases arises from the hepatic artery.…”

Anatomske variacije vej, ki izhajajo iz zgornje mezenterične arterije

“…Lahko je desna ali leva veja SMA, izvira kot samostojna veja ali kot dve hkrati (anteriorna in posteriorna). Izvira lahko tudi iz prve strokoVni čLanek jejunalne veje SMA (60-80 %) (2,3,5,11). IPDA oskrbuje spodnji del dvanajstnika, glavo in odrastek trebušne slinavke.…”

“…V primerih, ko IPDA ni prisotna, morajo kirurgi upoštevati neobičajni arterijski lok, da se izognejo nepotrebnim krvavitvam (12). Prav tako je potrebna velika pazljivost za IPDA zaradi nastalega skupnega debla med zgornjo jejunalno arterijo in IPDA (11).…”

Clinical Impact of Intraoperative Navigation Using a Doppler Ultrasonographic Guided Vessel Tracking Technique for Pancreaticoduodenectomy

“…As lymphatics (lymph node and lymph vessels) accompany the arteries and are distributed in the surrounding neural plexuses, complete clearance of peripancreatic tissue, including lymphatics and nerve plexus, is necessary for curative resection of the tumor. [1][2][3][4] As this operation is considered a complex procedure, a surgeon is required to be well trained in this specific surgical technique and to possess sufficient anatomic knowledge.Despite a low mortality rate and improvements in perioperative care and operative management, there is still a relatively high complication rate following PD. 5,6 Several studies showed that intraoperative bleeding and red blood cell (RBC) transfusion are serious risk factors of postoperative complications in PD.…”

“…As lymphatics (lymph node and lymph vessels) accompany the arteries and are distributed in the surrounding neural plexuses, complete clearance of peripancreatic tissue, including lymphatics and nerve plexus, is necessary for curative resection of the tumor. [1][2][3][4] As this operation is considered a complex procedure, a surgeon is required to be well trained in this specific surgical technique and to possess sufficient anatomic knowledge.…”