Vascular Anomalies Encountered During Pancreatoduodenectomy: Do They Influence Outcomes?

Abstract

The most common abnormalities of the hepatic vasculature include a replaced RHA, replaced LHA, and accessory RHA or LHA. Celiac artery stenosis secondary to median arcuate ligament compression may also be encountered. Every attempt should be made to preserve the aberrant vessel unless their resection is oncologically indicated. Routine preoperative computerized tomography angiography helps to identify the hepatic vascular anatomy and thereby prepares the surgeon to better deal with the vascular anomalies intraoperatively. Increased awareness of the vascular anatomy would decrease the chances of intraoperative vascular injury and consequent postoperative complications such as biliary anastomotic leaks as well as the chances of postoperative hemorrhage.

Anatomical variations of the coeliac trunk in the homogeneous Polish population

“…Preoperative knowledge of this anomaly is extremely important when planning pancreaticoduodenectomy which is the option for pancreatic and peripancreatic cancers treatment. The incidence of coeliac-mesenteric trunk increases a perioperative morbidity by 20-30% [28]. However, the proper coeliac-mesenteric trunk identification may help in choosing better treatment option and may both avoid iatrogenic injury and decrease the incidence of death.…”

Tricks and tips in pancreatoduodenectomy

“…A thorough knowledge of HA anatomy is essential; in the presence of HA anatomical variations (HAAV), accidental ligation may occur during PD, provoking hepatic necrosis, ischemic biliary injury or an anastomotic fistula [6,[20][21][22][23][24] . Preoperative assessment of peripancreatic vascular patterns using imaging methods is crucial for surgeons [22] .…”

“…Preoperative assessment of peripancreatic vascular patterns using imaging methods is crucial for surgeons [22] . Multidetector CT is the method of choice, and multidimensional reconstruction may be very useful [6,[21][22][23]25] . Angiography is no longer needed [20] .…”

“…Angiography is no longer needed [20] . Several classifications of HAAV have been proposed (Covey, Hiatt, Koops and Michels) [6,20,22,23] . The most frequently described HAAV are an anomalous RHA from the SMA (10%-21%), a displaced left HA (LHA) from the left gastric artery (4%-10%), displaced RHA and LHA, an accessory RHA and/or LHA (1%-8%), a displaced CHA from the SMA or aorta (0.4%-4.5%), and quadrifurcation of the HA itself [20,23] .…”

Surgery for Pancreatic Carcinoma: State of the Art

“…Multidetector computed tomography (MDCT) and angiography scans and magnetic resonance imaging (MRI) along with magnetic resonance cholangiopancreatography (MRCP) have been demonstrated to provide the highest accuracy in terms of non-invasive imaging modalities to diagnose, stage and determine the vascular involvement by pancreatic carcinomas of the head (>3 cm) [12][13][14][15], body and tail [16].…”