This article is the third part of a comprehensive review on the pancreatic arterial blood supply and deals with the inferior pancreaticoduodenal a. The aim of this review is to summarise the anatomical studies, starting from Haller's reports, and to supply as far as possible, with original material, angiographic evidences for the classic anatomical notions. For this purpose, the overall research was carried out by picking out and studying 1015 selective angiographies (celiac trunk and its branches, superior mesenteric a.) taken from the angiographic archives of the Institutes of Radiology of Siena, Rome (Catholic University), and Perugia. Angiographically, the authors observed the inferior pancreaticoduodenal a., present in most instances, as arising from the superior mesenteric a., from the right accessory hepatic a., or from a common trunk with the first or the first two jejunal aa. Some variations of the course have been shown. The authors underline and discuss the discordant opinions still existing regarding the incidence of the different ways the inferior pancreaticoduodenal a. arises and the surgical importance of the variation of origin of this artery.

The present article is the fourth part of a comprehensive review of the arterial blood supply of the pancreas and completes the study of the arterial vascularization of the pancreatic head dealing with the anterior inferior and posterior inferior pancreaticoduodenal aa. and with some minor sources of blood supply not involving the classical system of the pancreaticoduodenal arches. The aim of this review is to summarise the anatomical studies, starting from Haller's reports, and to supply, as far as possible with original material, angiographic evidence for the classic anatomical concepts. For this purpose, 1015 selective angiographs (celiac trunk and its branches, superior mesenteric a.) were taken from the angiographic archives of the Institutes of Radiology of Siena, Rome (Catholic University), and Perugia. These demonstrated the anterior inferior pancreaticoduodenal a., present in most instances, as arising from the inferior pancreaticoduodenal a., from a common trunk with the posterior inferior pancreaticoduodenal a. and the 1st jejunal a., from the 1st jejunal a. or from the superior mesenteric a.; on the other hand, the posterior inferior pancreaticoduodenal a. was more variable, originating from the inferior pancreaticoduodenal a., from a common trunk with the anterior inferior pancreaticoduodenal a. and the 1st jejunal a., from the superior mesenteric a., from the dorsal pancreatic a., or from a right accessory hepatic a. coming from the superior mesenteric a. In addition, minor branches to the head of the pancreas arose from the gastroduodenal a., the dorsal pancreatic a., the common hepatic a. and the inferior right phrenic a. Other origins of the inferior pancreaticoduodenal aa. previously reported, but not angiographically detectable with certainty, as well as further minor sources of blood supply to the head of the pancreas, have been listed. The differing opinions regarding the incidence of the various ways the inferior pancreaticoduodenal aa. arise are discussed and an attempt is made to explain the variability of the vascular anatomy of the pancreatic head on embryologic grounds.

No abstract

These findings seem to confirm the hypothesis of a silent cerebral microangiopathy affecting diabetic patients, with concomitant signs of microangiopathic damage in other districts.

The gross anatomy of the pancreatic blood supply has been subjected to numerous studies. The results of such studies, however, have never been summarized in detail, even in the most important textbooks. For this reason, a certain confusion was generated, especially regarding the interpretation of the nomenclature used to identify pancreatic arteries. This review summarizes more than two centuries of studies of the gross anatomy of the pancreatic blood supply, clarifies the arterial nomenclature, and underlines the aspects about which anatomists are not in agreement. Moreover, it supplies, as far as possible, documentary evidence for numerous observations previously reported only verbally. For this purpose, more than 200 references were directly consulted to provide the anatomical background of the topic, and more than 1000 angiograms were studied to support the review with original figures. The present paper, on the superior pancreaticoduodenal and anterior superior pancreaticoduodenal arteries, is the first of a series of articles dealing with the pancreatic blood supply.