Managing arterial collaterals due to coeliac axis stenosis during pancreaticoduodenectomy

Institute of Liver Studies, Kings College Hospital, London, UK.
JOP: Journal of the pancreas 02/2009; 10(5):547-9.
Source: PubMed


Coeliac artery stenosis is a condition affecting a minority of patients undergoing pancreaticoduodenectomy. In such cases, the development of collateral pathways through the blood supply of the pancreatic head provides challenges for surgical management.
We report a case of coeliac artery stenosis in a patient undergoing pancreaticoduodenectomy. The main blood supply for the coeliac axis was through a single collateral channel, formed by the anterior pancreaticoduodenal arterial arcade. We describe the preservation of this arcade, resection of the redundant artery with primary anastomosis and a review of the literature.
Management of coeliac artery stenosis during pancreaticoduodenectomy depends on identifying the cause and dealing with it accordingly, intraoperatively.

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Available from: Gabriele Marangoni
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    ABSTRACT: Appreciation and study of hepatic arterial anatomical variability is essential to the performance of a pancreaticoduodenectomy to avoid surgical complications such as bleeding, hepatic ischemia/failure, and anastomotic leak/stricture. Awareness of this variability permits the surgeon to adapt the surgical technique to deal with anomalies identified preoperatively or intraoperatively thereby preventing unnecessary surgical morbidity and mortality. The objective of our study is to provide a comprehensive review of the anatomic arterial anomalies and discuss surgical strategies that will equip the surgeon to deal with all anomalies that may be encountered a priori or en passant during the course of a Whipple procedure.
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