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Ghoneim B, Nash C, Akmenkalne L, Cremen S, Canning C, Colgan MP, O'Neill S, Martin Z, Madhavan P, O'Callaghan A. Staged treatment for pancreaticoduodenal artery aneurysm with coeliac artery revascularisation: Case report and systematic review. Vascular 2024; 32:162-178. [PMID: 36071691 DOI: 10.1177/17085381221124991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite being rare, pancreaticoduodenal artery aneurysms (PDAAs) carry a risk of rupture of up to 50% and are frequently associated with coeliac artery occlusion. METHODS PubMed and Embase databases were searched using appropriate terms. The systematic review was conducted according to PRISMA guidelines. RESULTS We present the case of a 2 cm pancreaticoduodenal artery aneurysm pre-operative angiography demonstrated that the coeliac artery was occluded and the pancreaticoduodenal artery was providing collateral blood supply to the liver. Treatment was a staged hybrid intervention inclusive of an aorto-hepatic bypass using a 6 mm graft, followed by coil embolisation of the aneurysm. We also present a systematic review of the management of PDAAs. Two hundred and ninety-two publications were identified initially with 81 publications included in the final review. Of the 258 peripancreatic aneurysms included, 175 (61%) were associated with coeliac artery disease either occlusion or stenosis. Abdominal pain was the main presentation in 158 cases. Rupture occurred in 111 (40%) of patients with only ten (3.8%) cases being unstable on presentation. Fifty (18%) cases were detected incidentally while investigating another pathology. Over half the cases (n=141/54.6%) were treated by trans arterial embolisation (TAE) alone, while 37 cases had open surgery only. Twenty-one cases needed TAE and a coeliac stent. Seventeen cases underwent hybrid treatment (open and endovascular). Sixteen cases were treated conservatively and in 26 cases, treatment was not specified. CONCLUSION PDAAs are commonly associated with coeliac artery disease. The most common presentation is pain followed by rupture. The scarcity of literature about true peripancreatic artery aneurysms associated with CA occlusive disease makes it difficult to assess the natural history or the appropriate treatment. Revascularisation of hepatic artery is better done with bypass in setting of median arcuate ligament compression and occluded celiac trunk.
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Affiliation(s)
- Baker Ghoneim
- Department of Vascular Surgery, St James Hospital, Dublin, Ireland
| | - Connor Nash
- Department of Vascular Surgery, St James Hospital, Dublin, Ireland
| | - Liga Akmenkalne
- Department of Vascular Surgery, St James Hospital, Dublin, Ireland
| | - Sinead Cremen
- Department of Vascular Surgery, St James Hospital, Dublin, Ireland
| | - Catriona Canning
- Department of Vascular Surgery, St James Hospital, Dublin, Ireland
| | - Mary P Colgan
- Department of Vascular Surgery, St James Hospital, Dublin, Ireland
| | - Sean O'Neill
- Department of Vascular Surgery, St James Hospital, Dublin, Ireland
| | - Zenia Martin
- Department of Vascular Surgery, St James Hospital, Dublin, Ireland
| | - Prakash Madhavan
- Department of Vascular Surgery, St James Hospital, Dublin, Ireland
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Fei K, Zani S, Ronald JS, Shortell CK, Southerland KW. A minimally invasive approach for management of pancreaticoduodenal artery and gastroduodenal artery aneurysm with celiac artery occlusion. J Vasc Surg Cases Innov Tech 2023; 9:101180. [PMID: 37388670 PMCID: PMC10300390 DOI: 10.1016/j.jvscit.2023.101180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/23/2023] [Indexed: 07/01/2023] Open
Abstract
Management of pancreaticoduodenal artery aneurysms (PDAAs) and gastroduodenal artery aneurysms (GDAAs) with concomitant celiac occlusion represents a challenging clinical scenario. Here, we describe a 62-year-old female with PDAA and GDAA complicated by celiac artery occlusion due to median arcuate ligament syndrome. We used a staged, minimally invasive approach consisting of: (1) a robotic median arcuate ligament release; (2) endovascular celiac artery stenting; and (3) visceral aneurysm coiling. The findings from this case report represent a novel treatment strategy for the management of PDAA/GDAA with celiac artery compression secondary to median arcuate ligament syndrome.
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Affiliation(s)
- Kaileen Fei
- Duke University School of Medicine, Durham, NC
| | - Sabino Zani
- Division of Surgical Oncology, Department of Surgery, Duke University Medical Center, Durham, NC
| | - James S. Ronald
- Division of Interventional Radiology, Department of Radiology, Duke University Medical Center, Durham, NC
| | - Cynthia K. Shortell
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Kevin W. Southerland
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
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Vani K, Calligaro KD, Maloni K, Madden N, Troutman DA, Dougherty MJ. Management of Pancreaticoduodenal Artery Aneurysms Based on a Single-Institution Experience. Vasc Endovascular Surg 2021; 55:684-688. [PMID: 34008440 DOI: 10.1177/15385744211017112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Pancreaticoduodenal artery aneurysms (PDAAs) are rare and have a high propensity for rupture. Historically, management of PDAAs included surgical reconstruction but has evolved with advances in endovascular therapy. We report our experience with management of PDAAs during the last 30 years. METHODS We retrospectively reviewed our prospectively maintained registry between January 1, 1992 - March 30, 2020. RESULTS We identified 8 patients with PDAAs: 4 with associated celiac artery occlusive disease and 4 without identifiable etiologies. Four patients were treated with surgical resection of the PDAAs: 2 intact aneurysms underwent concomitant revascularization (superior mesenteric artery-to-hepatic artery Dacron bypass; supra celiac aorta-to-hepatic artery Dacron bypass) and 2 (1 intact, 1 rupture) underwent ligation alone. Four patients were treated with coil embolization of the PDAA: 2 with concomitant stent-graft exclusion of the aneurysm (1 non-rupture, 1 rupture) and 2 without adjunctive measures (intact). There were no deaths nor any significant procedure-related morbidity. CONCLUSION Our large single-center experience shows that PDAAs can be successfully treated by open or endovascular intervention with selective revascularization.
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Affiliation(s)
- Kunal Vani
- Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia, PA, USA
| | - Keith D Calligaro
- Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia, PA, USA
| | - Krystal Maloni
- Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia, PA, USA
| | - Nicholas Madden
- Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia, PA, USA
| | - Douglas A Troutman
- Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia, PA, USA
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Park C, Park DE. Ruptured Pancreaticoduodenal Artery Aneurysm with Pancreatitis Treated Using Endovascular and Endoscopic Methods. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2021; 77:194-198. [PMID: 33896906 DOI: 10.4166/kjg.2021.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 11/03/2022]
Abstract
Pancreaticoduodenal artery aneurysm (PDAA) is a rare form of abdominal visceral aneurysm that accounts for approximately 2% of all cases. Most cases of PDAA are associated with celiac artery stenosis (CAS). Regardless of the size, there is a risk of rupture. Therefore, treatment should be performed immediately after discovery, even though the need to treat the accompanying CAS, if present, is controversial. The authors report a case of ruptured PDAA and accompanying pancreatitis treated using endovascular and endoscopic methods without treatment of CAS. A 50-year-old man was admitted to the emergency department of Wonkwang University Hospital with epigastric pain and hypovolemic shock. CT revealed a ruptured PDAA and a large volume hemoperitoneum. Emergency angiography was performed, and angioembolization of the PDAA was performed successfully. Follow-up CT revealed infection and pancreatitis, which were treated by surgical drainage and pancreatic duct stenting with ERCP. Because the degree of stenosis was not severe, it was decided to follow-up the accompanying CAS. After discharge, the patient was followed up without complications.
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Affiliation(s)
- Chan Park
- Department of Surgery, Wonkwang University School of Medicine, Iksan, Korea
| | - Dong Eun Park
- Department of Surgery, Wonkwang University School of Medicine, Iksan, Korea
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Outcomes After Open and Endovascular Repair of Non-Ruptured True Pancreaticoduodenal and Gastroduodenal Artery Aneurysms Associated with Coeliac Artery Compression: A Multicentre Retrospective Study. Eur J Vasc Endovasc Surg 2021; 61:945-953. [PMID: 33762153 DOI: 10.1016/j.ejvs.2021.02.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 02/01/2021] [Accepted: 02/16/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE True aneurysms of the peri-pancreatic arcade (PDAA) have been attributed to increased collateral flow related to coeliac axis (CA) occlusion by a median arcuate ligament (MAL). Although PDAA exclusion is currently recommended, simultaneous CA release and the technique to be used are debated. The aim of this retrospective multicentre study was to compare the results of open surgical repair of true non-ruptured PDAA with release or CA bypass (group A) vs. coil embolisation of PDAA and CA stenting or laparoscopic release (group B). METHODS From January 1994 to February 2019, 57 consecutive patients (group A: 31 patients; group B: 26 patients), including 35 (61%) men (mean age 56 ± 11 years), were treated at three centres. Twenty-six patients (46%) presented with non-specific abdominal pain: 15 (48%) in group A and 11 (42%) in group B (p = .80). RESULTS No patient died during the post-operative period. At 30 days, all PDAAs following open repair and embolisation had been treated successfully. In group A, all CAs treated by MAL release or bypass were patent. In group B, 2/12 CA stentings failed at < 48 hours, and all MAL released by laparoscopy were successful. Median length of hospital stay was significantly greater in group A than in group B (5 vs. 3 days; p = .001). In group A, all PDAAs remained excluded. In group B, three PDAA recanalisations following embolisation were treated successfully (two redo embolisations and one open surgical resection). At six years, Kaplan-Meier estimates of freedom for PDAA recanalisation were 100% in group A, and 88% ± 6% in group B (p = .082). No PDAA ruptured during follow up. In group A, all 37 CAs treated by MAL release were patent, and one aortohepatic bypass occluded. In group B, five CAs occluded: four after stenting and the other after laparoscopic MAL release with two redo stenting and three aortohepatic bypasses. Estimates of freedom from CA restenosis/occlusion were 95% ± 3% for MAL release or visceral bypass, and 60% ± 9% for CA stenting (p = .001). Two late restenoses following CA stenting were associated with PDAA recanalisation. CONCLUSION Current data suggest that open and endovascular treatment of PDAA can be performed with excellent post-operative results in both groups. However, PDAA embolisation was associated with few midterm recanalisations and CA stenting with a significant number of early and midterm failures.
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Ohta K, Shimohira M, Shoji J, Yoshida S, Takaishi T, Morimoto M, Matsuo Y, Ogawa T, Suda H, Shibamoto Y. Multiple large pancreaticoduodenal artery aneurysms due to celiac artery occlusion: Combination of the aorto-hepatic bypass and coil embolization with a dual approach through both the superior mesenteric artery and bypass. Radiol Case Rep 2020; 16:1-4. [PMID: 33144901 PMCID: PMC7596011 DOI: 10.1016/j.radcr.2020.10.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 10/12/2020] [Accepted: 10/17/2020] [Indexed: 11/28/2022] Open
Abstract
Pancreaticoduodenal artery aneurysm can occur from occlusion or stenosis of the celiac artery due to arteriosclerosis or median arcuate ligament compression. The risk of rupture of the aneurysm is independent of the aneurysmal diameter. A 78-year-old woman presented with multiple large aneurysms of the anterior superior pancreaticoduodenal artery. To preserve arterial flow to the liver, bypass grafting from the supra-celiac aorta to the common hepatic artery was performed at first. Coil embolization was successfully performed 10 days later with a dual approach through both the superior mesenteric artery and bypass. It was considered that the combination of the aorto-hepatic bypass and coil embolization was effective for the pancreaticoduodenal artery aneurysms due to celiac artery occlusion.
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Affiliation(s)
- Kengo Ohta
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Masashi Shimohira
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Jumpei Shoji
- Department of Radiology, Japanese Red Cross Nagoya Daini Hospital, Nagoya 466-8650, Japan
| | - Shiro Yoshida
- Department of Radiology, Nishichita General Hospital, Tokai 477-8522, Japan
| | - Taku Takaishi
- Department of Radiology, Konan Kosei Hospital, Konan 483-8704, Japan
| | - Mamoru Morimoto
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Science, Nagoya 467-8601, Japan
| | - Yoichi Matsuo
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Science, Nagoya 467-8601, Japan
| | - Tatsuhito Ogawa
- Department of Cardiovascular Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Hisao Suda
- Department of Cardiovascular Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
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Hirano K, Tokui T, Nakamura B, Inoue R, Hirano R, Maze Y, Chino S, Ito H, Shomura Y, Takao M. Understanding Vascular Anatomy is Key to Successful Endovascular Treatment of Pancreaticoduodenal Artery Aneurysms. Ann Vasc Dis 2020; 13:330-334. [PMID: 33384741 PMCID: PMC7751088 DOI: 10.3400/avd.cr.20-00011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Pancreaticoduodenal artery aneurysm (PDAA) is a rare disease without treatment guidelines. We present two patients with PDAA. The first patient was a 70-year-old man with a pseudoaneurysm in the anterior superior pancreaticoduodenal artery (ASPDA), for which we achieved exclusion by endovascular coil embolization. The second patient was a 63-year-old woman with a PDAA in the ASPDA with celiac axis obstruction. Endovascular coil embolization of the aneurysm and the ASPDA was successful without visceral organ ischemia. Endovascular treatment is effective for PDAAs, but careful evaluation of collateral circulation is vital in PDAAs with celiac axis obstruction.
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Affiliation(s)
- Koji Hirano
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | - Toshiya Tokui
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | - Bun Nakamura
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | - Ryosai Inoue
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | - Reina Hirano
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | - Yasumi Maze
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | - Shuji Chino
- Department of Radiology, Ise Red Cross Hospital
| | - Hisato Ito
- Department of Thoracic and Cardiovascular Surgery, Mie University Hospital
| | - Yu Shomura
- Department of Thoracic and Cardiovascular Surgery, Mie University Hospital
| | - Motoshi Takao
- Department of Thoracic and Cardiovascular Surgery, Mie University Hospital
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Causal Relationship between Celiac Stenosis and Pancreaticoduodenal Artery Aneurysm: Interpretation by Simulation Using an Electric Circuit. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2738726. [PMID: 32596287 PMCID: PMC7298276 DOI: 10.1155/2020/2738726] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/29/2020] [Accepted: 05/16/2020] [Indexed: 01/06/2023]
Abstract
Pancreaticoduodenal artery (PDA) aneurysm and celiac artery (CA) stenosis are rare diseases in themselves. Interestingly, however, there are more cases documented in the literature in which these two disease entities occurred together than could be coincidental, and CA stenosis has been suggested as the provocative condition in developing PDA aneurysm. This study is aimed at examining the causal relationship between CA stenosis and PDA aneurysm by simulating the splanchnic circulation with an electric circuit. A patient with multiple PDA aneurysms and collaterals with CA stenosis was treated in our institution using hybrid techniques. The patient's pre- and postoperative status was simulated using an electric circuit, and the two possible scenarios were tested for compatibility: the stenosis-first scenario vs. the aneurysm-first scenario. The simulation was performed in two ways: using Simulink® software (MATLAB® Release 2018b) and actual circuit construction on a breadboard. The stenosis-first scenario showed that as the CA stenosis progresses, the blood flow through PDA increases, favoring the development of an aneurysm and/or collaterals if the artery was already compromised by a weakening condition. On the other hand, the aneurysm-first scenario also showed that if the aneurysm or collaterals developed first, the aneurysm will steal the blood flow through the CA, causing it to collapse if the artery was already compromised by increased wall tension. Contrary to the common belief, this study showed that in patients suffering from concurrent CA stenosis and PDA aneurysm, either condition could develop first and predispose the development of the other. The simulation of splanchnic blood flow with an electric circuit provides a useful tool for analyzing rare vascular diseases that are difficult to provoke in clinical and animal studies.
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Blood flow modification might prevent secondary rupture of multiple pancreaticoduodenal artery arcade aneurysms associated with celiac axis stenosis. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:41-45. [PMID: 32072085 PMCID: PMC7016350 DOI: 10.1016/j.jvscit.2019.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 10/13/2019] [Indexed: 12/18/2022]
Abstract
A pancreaticoduodenal artery arcade aneurysm (PDAA) is rare and often associated with celiac axis stenosis by the median arcuate ligament. Although rupture risk of the PDAA is not related to its size, treatment guidelines are absent. Here we describe a 59-year-old woman with multiple ruptured PDAAs associated with celiac axis stenosis who was successfully treated with coil embolization. As follow-up computed tomography revealed rapid expansion of residual PDAAs and new gastric artery dissection, median arcuate ligament resection was followed by aorta-common hepatic artery bypass, which resulted in aneurysmal regression. Blood flow modification might prevent secondary rupture of PDAA associated with celiac axis stenosis.
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Imagami T, Takayama S, Hattori T, Matsui R, Kani H, Tanaka A, Ando M, Kodani N. Transarterial Embolization With Complementary Surgical Ligation of Gastroduodenal Artery for Ruptured Pancreaticoduodenal Artery Aneurysm. Vasc Endovascular Surg 2019; 53:593-598. [PMID: 31248357 DOI: 10.1177/1538574419859693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The association between pancreaticoduodenal artery aneurysm (PDAA) and local hemodynamic changes in pancreaticoduodenal arcades is well established. However, there are few case reports of PDAA associated with acute aortic dissection. In this article, we outline and discuss the case of a 61-year-old man diagnosed with a type A acute aortic dissection who underwent emergency surgery and developed sudden-onset severe abdominal pain and shock 10 days later. Contrast-enhanced computed tomography showed a ruptured PDAA with feeding vessels from the gastroduodenal and superior mesenteric arteries, with evidence that the celiac artery was diverged from a false lumen. Transarterial embolization via the superior mesenteric artery alone was not expected to achieve hemostasis, so we performed a hybrid procedure involving transarterial embolization cannulated from superior mesenteric artery with complementary surgical ligation of the gastroduodenal artery. The postoperative course was uneventful, and follow-up contrast-enhanced computed tomography showed no persistence of the aneurysm 8 days after the second operation. This case proposed that visceral arterial malperfusion due to acute aortic dissection can cause PDAA in the early postoperative period. Although previous reports suggest that endovascular treatment is preferable, it may not always be feasible. Since ruptured PDAAs are often not detected during surgery, surgical treatment can be overly invasive. Whereas, transarterial embolization with complementary clamping or ligation of the gastroduodenal artery for ruptured PDAA is less invasive and can control hemorrhage, especially when cannulation to the celiac artery is impossible. Notably, the technique did not cause organ ischemia, presumably because the small collateral vessels of the pancreaticoduodenal arcades permitted sufficient blood flow. If endovascular treatment is unable to achieve rapid hemostasis, this technique may be a useful option for ruptured PDAA.
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Affiliation(s)
- Toru Imagami
- 1 Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai City, Japan
| | - Satoru Takayama
- 1 Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai City, Japan
| | - Taku Hattori
- 1 Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai City, Japan
| | - Ryohei Matsui
- 1 Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai City, Japan
| | - Hisanori Kani
- 1 Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai City, Japan
| | - Akimitsu Tanaka
- 2 Department of Cardiology of Heart Center, Nagoya Tokushukai General Hospital, Kasugai City, Japan
| | - Miyuki Ando
- 2 Department of Cardiology of Heart Center, Nagoya Tokushukai General Hospital, Kasugai City, Japan
| | - Noriko Kodani
- 3 Department of Cardiovascular Surgery, Nagoya Tokushukai General Hospital, Kasugai City, Japan
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Giovanardi F, Lai Q, Garofalo M, Arroyo Murillo GA, Choppin de Janvry E, Hassan R, Larghi Laureiro Z, Consolo A, Melandro F, Berloco PB. Collaterals management during pancreatoduodenectomy in patients with celiac axis stenosis: A systematic review of the literature. Pancreatology 2018; 18:592-600. [PMID: 29776725 DOI: 10.1016/j.pan.2018.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 05/07/2018] [Accepted: 05/09/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES Celiac axis stenosis (CAS) represents an uncommon and typically innocuous condition. However, when a pancreatic resection is required, a high risk for upper abdominal organs ischemia is observed. In presence of collaterals, such a risk is minimized if their preservation is realized. The aim of the present study is to systematically review the literature with the intent to address the routine management of collateral arteries in the case of CAS patients requiring pancreatoduodenectomy. METHODS A systematic search was done in accordance with the PRISMA guidelines, using "celiac axis stenosis" AND "pancreatoduodenectomy" as MeSH terms. Seventy-four articles were initially screened: eventually, 30 articles were identified (n = 87). RESULTS The main cause of CAS was median arcuate ligament (MAL) (n = 31; 35.6%), followed by atherosclerosis (n = 20; 23.0%). CAS was occasionally discovered during the Whipple procedure in 15 (17.2%) cases. Typically, MAL was divided during surgery (n = 24/31; 77.4%). In the great majority of cases (n = 83; 95.4%), vascular abnormalities involved the pancreatoduodenal arteries (i.e., dilatation, arcade, channels, aneurysms). Collateral arteries were typically preserved, being divided or reconstructed in only 14 (16.1%) cases, respectively. Severe ischemic complications were reported in six (6.9%) patients, 20.0% of whom were reported in patients with preoperatively unknown CAS (p-value 0.06). CONCLUSIONS A correct pre-operative evaluation of anatomical conditions as well as a correct surgical planning represent the paramount targets in CAS patients with arterial collaterals. Vascular flow must be always safeguarded preserving/reconstructing the collaterals or resolving the CAS, with the final intent to avoid dreadful intra- and post-operative complications.
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Affiliation(s)
- Francesco Giovanardi
- General Surgery and Organ Transplantation Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy.
| | - Quirino Lai
- Hepato-bilio-pancreatic and Liver Transplant Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - Manuela Garofalo
- General Surgery and Organ Transplantation Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - Gabriela A Arroyo Murillo
- General Surgery and Organ Transplantation Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - Eleonore Choppin de Janvry
- General Surgery and Organ Transplantation Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - Redan Hassan
- Hepato-bilio-pancreatic and Liver Transplant Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - Zoe Larghi Laureiro
- Hepato-bilio-pancreatic and Liver Transplant Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - Adriano Consolo
- General Surgery and Organ Transplantation Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - Fabio Melandro
- General Surgery and Organ Transplantation Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - Pasquale B Berloco
- General Surgery and Organ Transplantation Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy
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Usefulness of four-dimensional flow-sensitive magnetic resonance imaging to evaluate hemodynamics in the pancreaticoduodenal artery. Clin J Gastroenterol 2018; 11:327-332. [DOI: 10.1007/s12328-018-0844-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 02/25/2018] [Indexed: 10/17/2022]
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