Gastroduodenal artery: single key for many locks

Abstract

Gastroduodenal artery (GDA) commonly arises from common hepatic artery, a branch of celiac axis. It holds a unique anatomical position that connects the foregut and midgut due to its intimate communications with foregut and midgut arterial supply. Its numerous anatomical variations have a significant impact on planning and performance of hepatopancreaticobiliary (HPB) surgery. Its close relation to the first part of duodenum, common bile duct and head of pancreas makes it susceptible for inadvertent bleeding during or after surgery, or due to various HPB pathologies. Also, a large number of vascular interventions rely on GDA and its branches. Careful preoperative planning is the key and a detailed knowledge and awareness of its variant anatomy is of paramount importance, be it liver resections, liver transplant, biliary and pancreatic resections and pancreatic transplant or transarterial procedures involving these arteries. GDA can also be a cause of gastrointestinal hemorrhage due to true or pseudoaneurysms and anatomy has significant implications on its management. The article provides a succinct review on relevance of GDA anatomy and variations and highlights that preoperative planning and intraoperative awareness of variations is the key to performance of safe HPB surgery and interventions.

Supraduodenal and Right Gastric Arteries Originating from A Common Trunk: A Rare Anatomical Variant

“…The SDA, which was first described by Wilkie in 1911, supplies blood to the proximal duodenum [4]. According to previous studies, the SDA most commonly originates from the GDA (26%-55%), followed by the LHA (9%-20%), CHA or PHA (20%), RGA (8%-13%), and less commonly, the cystic artery or PSPDA [4][5][6][7]. Wilkie stated that SDA appeared to be an end artery in most cases [4].…”

“…To prevent these adverse effects, the SDA and RGA are commonly embolized prior to HAIC as long as these arteries branch from the gastroduodenal artery (GDA). Anatomic variations of SDA and RGA are widely known [1][2][3][4][5][6][7][8][9]. It is important for vascular interventional radiologists to recognize these variations.…”

Role of Radiology in the Preoperative Detection of Arterial Calcification and Celiac Trunk Stenosis and Its Association with Anastomotic Leakage Post Esophagectomy, an Up-to-Date Review of the Literature

“…The most cranial part of the GC used for the construction of the anastomosis is particularly vulnerable in terms of arterial supply, since it is exclusively supplied by the right gastroepiploic artery, one of the terminal branches of the gastroduodenal artery deriving from the common hepatic artery [ 25 ]. The anatomy of the gastroduodenal artery varies though, and this vessel may also arise from the left or the right hepatic arteries, or even directly from the celiac trunk [ 26 ].…”

Pancreaticoduodenectomy preserving aberrant gastroduodenal artery utilized in a previous coronary artery bypass grafting

“…[ 7 , 8 ] Contrarily, a gastroduodenal artery (GDA) variation is scarce and causes concern. [ 9 ] GDA usually arises from the common HA (CHA) as a branch of the celiac axis (CeA), and the vessel is usually dissected during conventional PD. We experienced the case of ampullary cancer with a rare arterial anomaly, replaced GDA (rGDA), [ 9 – 11 ] which originates from the superior mesenteric artery (SMA).…”

“…[ 9 ] GDA usually arises from the common HA (CHA) as a branch of the celiac axis (CeA), and the vessel is usually dissected during conventional PD. We experienced the case of ampullary cancer with a rare arterial anomaly, replaced GDA (rGDA), [ 9 – 11 ] which originates from the superior mesenteric artery (SMA). The patient also had an operative history of coronary artery bypass grafting (CABG) using the right gastroepiploic artery (RGEA).…”