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Veranyan N, Willie-Permor D, Zarrintan S, Malas MB. Clinical outcomes of celiac artery coverage vs preservation during thoracic endovascular aortic repair. J Vasc Surg 2024:S0741-5214(24)01501-5. [PMID: 38986961 DOI: 10.1016/j.jvs.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 07/02/2024] [Accepted: 07/02/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVE Adequate proximal and distal seal zones are necessary for successful thoracic endovascular aortic repair (TEVAR). Often, the achievement of an adequate distal seal zone requires celiac artery (CA) coverage by endograft with or without preservation of CA blood flow. The outcomes of CA coverage without its flow preservation were studied only in small case series. This study aims to determine the difference in outcomes between CA coverage with vs without preservation of CA blood flow during TEVAR using a multi-institutional national database. METHODS The Vascular Quality Initiative database was reviewed for all TEVAR patients distally landing in zone 6. The cohort was divided into TEVAR with vs without CA flow preservation. Demographic, clinical, and perioperative characteristics, as well as postoperative mortality, morbidities, and complications, were compared between the groups. Univariate and multivariate regression analyses were performed. RESULTS Of 25,549 reviewed patients, 772 had a distal landing in Zone 6, 212 of which (27.5%) had TEVAR without CA flow preservation, whereas 560 (72.5%) underwent TEVAR with CA flow preservation. Indications for TEVAR were aneurysm in 431 (55.8%), dissection in 247 (32.0%), or other in 94 (12.2%) cases. Patients who underwent TEVAR without CA flow preservation had statistically significantly higher rates of 30-day mortality (11.3% vs 5.9%; P = .010), 30-day disease/treatment-related mortality (8.0% vs 4.3%; P = .039), as well as a tendency of increased intestinal ischemia requiring intervention (1.9% vs 0.5%; P = .077). After adjusting for potential confounders, CA coverage without flow preservation was associated with more than a two-fold increase in the overall 30-day mortality (odds ratio [OR], 2.83; 95% confidence interval [CI], 1.35-5.92; P = .006) and 30-day disease/treatment-related mortality (OR, 2.72; 95% CI, 1.11-6.72; P = .029). In a sub-group analysis based on disease pathology, these results persisted only in the aneurysm group (30-day mortality [OR, 2.36; 95% CI, 1.01-5.48; P = .047]; 30-day disease/treatment-related mortality [OR, 2.88; 95% CI, 1.08-7.67; P = .034]), whereas there was no significant association between CA flow preservation status and the endpoints in the dissection subgroup (30-day mortality [OR, 1.16; 95% CI, 0.22-6.05; P = .856], 30-day disease/treatment-related mortality [OR, 0.90; 95% CI, 0.16-5.19; P = .911]). CONCLUSIONS CA coverage during TEVAR without preservation of its blood flow is associated with significantly higher mortality in patients with aortic aneurysm, but not dissection. In patients with aortic aneurysm, CA flow should be preserved during TEVAR whenever feasible, whereas in patients with dissection, it may be safe to cover CA without preservation of its flow. Prospective studies should be done to confirm these findings and compare the open vs endovascular revascularization techniques on outcomes.
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Affiliation(s)
- Narek Veranyan
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Diego, La Jolla, CA; Center for Learning & Excellence in Vascular & Endovascular Research (CLEVER), Department of Surgery, University of California San Diego, La Jolla, CA
| | - Daniel Willie-Permor
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Diego, La Jolla, CA; Center for Learning & Excellence in Vascular & Endovascular Research (CLEVER), Department of Surgery, University of California San Diego, La Jolla, CA
| | - Sina Zarrintan
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Diego, La Jolla, CA; Center for Learning & Excellence in Vascular & Endovascular Research (CLEVER), Department of Surgery, University of California San Diego, La Jolla, CA
| | - Mahmoud B Malas
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Diego, La Jolla, CA; Center for Learning & Excellence in Vascular & Endovascular Research (CLEVER), Department of Surgery, University of California San Diego, La Jolla, CA.
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Dmitriev I, Oganesyan M, Popova A, Orlov E, Sinelnikov M, Zharikov Y. Anatomical basis for pancreas transplantation via isolated splenic artery perfusion: A literature review. World J Clin Cases 2022; 10:12844-12853. [PMID: 36569006 PMCID: PMC9782932 DOI: 10.12998/wjcc.v10.i35.12844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/10/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022] Open
Abstract
The variability of vascular anatomy of the pancreas underlines the difficulty of its transplantation. Research regarding the consistency of anatomical variations shows splenic arterial dominance in most cases. This can significantly improve transplantation success. A systematic literature review was performed according to the quality standards described in the AMSTAR measurement tool and the PRISMA guidelines. We valuated existing literature regarding the vascularization and blood perfusion patterns of the pancreas in terms of dominance and variability. The collected data was independently analyzed by two researchers. Variance of vascular anatomy was seen to be underreported in literature, though significant findings have been included and discussed in this study, providing valuable insight into the dynamics of pancreatic perfusion and feasibility of transplantation on several different supplying arteries. The splenic artery (SA) has a high percentage of consistency in all found studies (over 90%). High frequency of anastomoses between arterial pools supplying the pancreas can mediate sufficient blood supply through a dominant vessel, such as the SA, which is present in most cases. Pancreatic transplantation with isolated SA blood supply can provide sufficient arterial perfusion of the pancreas for stable transplant viability due to high anatomical consistency of the SA and vast communications with other arterial systems.
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Affiliation(s)
- Ilya Dmitriev
- Department of Pancreas and Kidney Transplantation, N.V. Sklifosovsky Research Institute for Emergency Care, Moscow 107045, Russia
| | - Marine Oganesyan
- Department of Human Anatomy, Sechenov First Moscow State Medical University (Sechenov University), Moscow 125009, Russia
| | - Antonina Popova
- Department of Human Anatomy, Sechenov First Moscow State Medical University (Sechenov University), Moscow 125009, Russia
| | - Egor Orlov
- Department of Human Anatomy, Sechenov First Moscow State Medical University (Sechenov University), Moscow 125009, Russia
| | - Mikhail Sinelnikov
- Department of Human Anatomy, Sechenov First Moscow State Medical University (Sechenov University), Moscow 125009, Russia
- Department of Oncology, Radiotherapy and Reconstructive Surgery, Sechenov First Moscow State Medical University (Sechenov University), Moscow 119048, Russia
- Laboratory of clinical morphology, Research Institute of Human Morphology, Moscow 117418, Russia
| | - Yury Zharikov
- Department of Human Anatomy, Sechenov First Moscow State Medical University (Sechenov University), Moscow 125009, Russia
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Liang HW, Zhou Y, Zhang ZW, Yan GW, Du SL, Zhang XH, Li XY, Lv FJ, Zheng Q, Li YM. Dual-energy CT with virtual monoenergetic images to improve the visualization of pancreatic supplying arteries: the normal anatomy and variations. Insights Imaging 2022; 13:21. [PMID: 35122162 PMCID: PMC8816990 DOI: 10.1186/s13244-022-01157-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/07/2022] [Indexed: 12/31/2022] Open
Abstract
Background Pancreatic ductal adenocarcinoma (PDAC) remains a malignancy with poor prognosis, appropriate surgical resection and neoadjuvant therapy depend on the accurate identification of pancreatic supplying arteries. We aim to evaluate the ability of monoenergetic images (MEI [+]) of dual-energy CT (DECT) to improve the visualization of pancreatic supplying arteries compared to conventional polyenergetic images (PEI) and investigate the implications of vascular variation in pancreatic surgery and transarterial interventions. Results One hundred patients without pancreatic diseases underwent DECT examinations were retrospectively enrolled in this study. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) at 40-keV MEI (+) were significantly higher than those of PEI (p < 0.05). All subjective MEI (+) scores were significantly higher than those of PEI (p < 0.05). The visualization rates were significantly higher for posterior superior pancreaticoduodenal artery (PSPDA), anterior and posterior inferior pancreaticoduodenal artery (AIPDA, PIPDA), anterior and posterior pancreaticoduodenal arcade (APAC, PPAC), transverse and caudal pancreatic artery (TPA, PCA) at 40-keV MEI (+) than those of PEI (p < 0.05). However, there were no significant differences for visualizing anterior superior pancreaticoduodenal artery (ASPDA), inferior pancreaticoduodenal artery (IPDA), dorsal and magnificent pancreatic artery (DPA, MPA) between 40-keV MEI (+) and PEI (p > 0.05). Four types of variations were observed in the origin of DPA and three to five types in the origin of PSPDA, AIPDA and PIPDA. Conclusions 40-keV MEI (+) of DECT improves the visualization and objective and subjective image quality of pancreatic supplying arteries compared to PEI. Pancreatic supplying arteries have great variations, which has important implications for preoperative planning of technically challenging surgeries and transarterial interventions.
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Affiliation(s)
- Hong-Wei Liang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Yang Zhou
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Zhi-Wei Zhang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Gao-Wu Yan
- Department of Radiology, Suining Central Hospital, Suining, 629000, China
| | - Si-Lin Du
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Xiao-Hui Zhang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Xin-You Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Qiao Zheng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
| | - Yong-Mei Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
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Omotehara T, Naito M, Hayashi S, Kawata S, Shimada K, Itoh M. Common hepatic artery originating from superior mesenteric artery with replaced right hepatic artery. Anat Sci Int 2021; 96:568-571. [PMID: 33420976 DOI: 10.1007/s12565-020-00599-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 12/26/2020] [Indexed: 10/22/2022]
Abstract
We found a variational case relating to the arteries distributed to the liver and pancreas during the routine cadaver dissection course. The common hepatic artery originated from the superior mesenteric artery as the first branch. The common hepatic artery was soon divided into the left and right hepatic arteries and distributed to the left and right lobe of the liver. The superior pancreaticoduodenal artery arose from the gastroduodenal artery, a branch of the left hepatic artery. The inferior pancreaticoduodenal artery originated from the superior mesenteric artery. Besides, two posterior branches of the right hepatic artery supplied the duodenum and the head of the pancreas. The arterial arcades were formed behind the head of the pancreas among the superior pancreaticoduodenal artery and these two posterior branches of the right hepatic artery. In conclusion, this case can be considered a rare case in which the replaced common hepatic artery and replaced right hepatic artery occurred simultaneously. The coexisting of these two replaced arteries suggests that the developmental processes to form these variations are independent.
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Affiliation(s)
- Takuya Omotehara
- Department of Anatomy, Tokyo Medical University, 6-1-1, Shinjuku, Shinjuku-Ku, Tokyo, 160-8402, Japan.
| | - Michiko Naito
- Division of Anatomical Science, Department of Functional Morphology, Nihon University School of Medicine, 30-1, Oyaguchi Kami-cho, Itabashi-Ku, Tokyo, 173-8610, Japan
| | - Shogo Hayashi
- Division of Basic Medical Science, Department of Anatomy, Tokai University School of Medicine, 143, Shimokasuya, Isehara-shi, 259-1193, Kanagawa, Japan
| | - Shinichi Kawata
- Department of Anatomy, Tokyo Medical University, 6-1-1, Shinjuku, Shinjuku-Ku, Tokyo, 160-8402, Japan
| | - Kazuyuki Shimada
- Department of Anatomy, Tokyo Medical University, 6-1-1, Shinjuku, Shinjuku-Ku, Tokyo, 160-8402, Japan.,Division of Anatomical Science, Department of Functional Morphology, Nihon University School of Medicine, 30-1, Oyaguchi Kami-cho, Itabashi-Ku, Tokyo, 173-8610, Japan
| | - Masahiro Itoh
- Department of Anatomy, Tokyo Medical University, 6-1-1, Shinjuku, Shinjuku-Ku, Tokyo, 160-8402, Japan
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Kumar KH, Garg S, Yadav TD, Sahni D, Singh H, Singh R. Anatomy of peripancreatic arteries and pancreaticoduodenal arterial arcades in the human pancreas: a cadaveric study. Surg Radiol Anat 2021; 43:367-375. [PMID: 33392701 DOI: 10.1007/s00276-020-02632-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 11/17/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The purpose of this work was to evaluate the arteries supplying the pancreaticoduodenal (PD) complex. MATERIALS AND METHODS The study was conducted on 15 fresh enbloc pancreatic specimens by latex injection method which enabled the visualization of the peripancreatic arteries and their minute branches. RESULTS The gastroduodenal (GDA), anterior superior pancreaticoduodenal (ASPD), and anterior inferior pancreaticoduodenal (AIPD) artery was found in all the cases, whereas the posterior superior pancreaticoduodenal (PSPD) and posterior inferior pancreaticoduodenal (PIPD) artery was present in 93.34% cases. The ASPD artery originated from GDA in all the cases. Two types of variations were observed in the origin of PSPD artery and four types each in the origin of AIPD and PIPD artery. Anatomical and numerical variations were observed in both anterior and posterior arches, posterior arch being absent in 20% cases. CONCLUSIONS In the present study, an attempt was made to systematically describe the individual arterial configurations of the PD complex. The information provided here has important implications for preoperative planning of technically challenging surgeries and interventions around the pancreatic head.
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Affiliation(s)
- K Hemanth Kumar
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Shallu Garg
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Thakur Deen Yadav
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Daisy Sahni
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harsimranjit Singh
- Department of Anatomy, All India Institute of Medical Sciences, Bathinda, India
| | - Rajinder Singh
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
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Banno H, Ikeda S, Kawai Y, Meshii K, Takahashi N, Sugimoto M, Kodama A, Komori K. Early and midterm outcomes of celiac artery coverage during thoracic endovascular aortic repair. J Vasc Surg 2020; 72:1552-1557. [DOI: 10.1016/j.jvs.2020.02.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 02/09/2020] [Indexed: 11/30/2022]
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Macchi V, Picardi EEE, Morra A, Porzionato A, De Caro R. Pancreaticoduodenal arterial arcades: Their dominance and variations-their potential clinical relevance. Clin Anat 2018; 32:469-470. [PMID: 30362628 DOI: 10.1002/ca.23307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 10/19/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Veronica Macchi
- Institute of Human Anatomy, Department of Neurosciences, University of Padova, Padova, Italy
| | | | - Aldo Morra
- Section of Radiology, Euganea Medica Center, Padova, Italy
| | - Andrea Porzionato
- Institute of Human Anatomy, Department of Neurosciences, University of Padova, Padova, Italy
| | - Raffaele De Caro
- Institute of Human Anatomy, Department of Neurosciences, University of Padova, Padova, Italy
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