Blood supply to the duodenal papilla and the communicating artery between the anterior and posterior pancreaticoduodenal arterial arcades

Abstract

The communicating artery (ComA) between the anterior and posterior pancreaticoduodenal arterial arcades is little understood, although it has been described several times during the past 100 years. In 44 of 51 cadaveric specimens in the present study, the typical ComA was observed to pass between the major and accessory pancreatic ducts. In addition, a second ComA was sometimes found crossing inferior to the major pancreatic duct. The typical ComAs often (36 of the 44) issued papillary branch(es). Although direct papillary branches of the posterior arcade were often observed to either coexist with (9 specimens) or exist independently (4 specimens), the ComA-derived branch seemed to be critical for papillary blood supply, because of its shorter length, greater thickness, and higher frequency. Moreover, the typical ComA could be a good landmark during limited pancreatic resection, such as duodenum-preserving subtotal resection of the pancreatic head or pancreatic segment resection, because the artery is likely to be an indicator of the borders between the celiac and superior mesenteric arterial territories, as well as those between the ventral and dorsal segments of the pancreas.

Effect of preventive closure of the frenulum after endoscopic papillectomy: A prospective pilot study

“…The following three factors made frenulum to be vulnerable for bleeding. Firstly, as feeding artery of the lower part of the ampulla including frenulum is tripled supplied with anterior superior pancreaticoduodenal artery, posterior superior pancreaticoduodenal artery, and inferior pancreartic artery . Second is the vulnerable site for delayed bleeding.…”

Pancreaticoduodenal arterial arcades: Their dominance and variations—their potential clinical relevance

“…Falconer and Griffiths () found it in 11 cases of a series composed of 27 dissections and 23 corrosion casts. This anastomotic arcade occurred in 20% of our series, while Yamaguchi et al () found it surprisingly as an almost constant vascular variation (86%) in 51 examined Japanese samples.…”

Embolization of post-biliary sphincterotomy bleeding refractory to medical and endoscopic therapy: technical results, clinical efficacy and predictors of outcome

“…This type of embolic agent penetrates deeply into the targeted tissues and blocks the arterial circulation at the level of arterioles with a diameter of 300-500 micron. The rich collateral arterial network in the upper abdomen, with many anastomoses, particularly between the anterior and posterior pancreaticoduodenal arcades, may explain the absence of ischaemic complications after aggressive embolotherapy [15].…”