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Furuya R, Takeda Y, Takahashi A, Ito R, Ichida H, Yoshioka R, Mise Y, Inoue Y, Takahashi Y, Saiura A. Comparative outcomes of parenchyma-sparing repeat pancreatectomy vs completion pancreatectomy: impact on endocrine function and diabetes management. J Gastrointest Surg 2025; 29:102040. [PMID: 40154836 DOI: 10.1016/j.gassur.2025.102040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2025] [Revised: 03/01/2025] [Accepted: 03/22/2025] [Indexed: 04/01/2025]
Abstract
BACKGROUND Although completion pancreatectomy (CP) is the standard approach for repeat pancreatectomy of secondary pancreatic tumors, the incidence of postoperative endocrine insufficiency is high. Parenchyma-sparing repeat pancreatectomy (PSRP) can preserve this function. However, its feasibility and long-term outcomes have not been evaluated. This study compared short-term outcomes and long-term endocrine pancreatic function between PSRP and CP. METHODS Consecutive patients who underwent a second pancreatectomy between April 2005 and March 2024 at 2 high-volume centers were included. This study compared the short- and long-term outcomes between the PSRP and CP groups. Serum hemoglobin A1c (HbA1c) levels 6 months after surgery and the occurrence of hypoglycemic episodes were evaluated as indicators of endocrine function. RESULTS A total of 30 patients (11 in the PSRP group and 19 in the CP group) were included. The 2 groups showed no significant differences in the preoperative or intraoperative findings. None of the patients in the PSRP group experienced major morbidity (Clavien-Dindo grade of ≥III), whereas 4 patients (21%) in the CP group experienced major morbidity. HbA1c levels and the requirement for insulin therapy were significantly lower in the PSRP group than in the CP group (6.2% vs 7.6% [P <.001] and 27.0% vs 100.0% [P <.001], respectively). Hypoglycemic episodes were observed only in the CP group (4 patients). CONCLUSION PSRP might have favorable short-term outcomes and better long-term endocrine function than CP.
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Affiliation(s)
- Ryoji Furuya
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Hongo, Tokyo, Japan
| | - Yoshinori Takeda
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Hongo, Tokyo, Japan
| | - Atsushi Takahashi
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Hongo, Tokyo, Japan
| | - Ryota Ito
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Hongo, Tokyo, Japan; Department of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake, Tokyo, Japan
| | - Hirofumi Ichida
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Hongo, Tokyo, Japan
| | - Ryuji Yoshioka
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Hongo, Tokyo, Japan
| | - Yoshihiro Mise
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Hongo, Tokyo, Japan
| | - Yosuke Inoue
- Department of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake, Tokyo, Japan
| | - Yu Takahashi
- Department of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake, Tokyo, Japan
| | - Akio Saiura
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Hongo, Tokyo, Japan.
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Valenzuela-Fuenzalida JJ, Núñez-Castro CI, Morán-Durán VB, Nova-Baeza P, Orellana-Donoso M, Suazo-Santibáñez A, Becerra-Farfan A, Oyanedel-Amaro G, Bruna-Mejias A, Granite G, Casanova-Martinez D, Sanchis-Gimeno J. Anatomical Variants in Pancreatic Irrigation and Their Clinical Considerations for the Pancreatic Approach and Surrounding Structures: A Systematic Review with Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:666. [PMID: 40282957 PMCID: PMC12028877 DOI: 10.3390/medicina61040666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2025] [Revised: 03/26/2025] [Accepted: 04/01/2025] [Indexed: 04/29/2025]
Abstract
Background and Objectives: The pancreas receives blood through a complex network of multiple branches, primarily originating from the celiac trunk (CeT) and the superior mesenteric artery (SMA). This blood supply is structured into three main arterial groups, each serving different regions of the pancreas to effectively support its endocrine and exocrine functions. Materials and Methods: The databases Medline, Scopus, Web of Science, Google Scholar, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Latin American and the Caribbean Literature in Health Sciences (LILACS) were searched until January 2025. Methodological quality was evaluated using an assurance tool for anatomical studies (AQUA). Pooled prevalence was estimated using a random effects model. Results: A total of sixteen studies met the established selection criteria in this study for meta-analysis. Pancreatic irrigation variants presented a prevalence of 11.2% (CI: 7-14%) and a heterogeneity of 88.2%. The other studies were analyzed by subgroups, showing statistically significant differences in the following subgroups: (1) sample type-a larger sample of images analyzed in the included studies (p = 0.312), which did not show statistically significant differences; (2) geographical region (p = 0.041), which showed a greater presence in the Asian population studied, and this was statistically significant; and (3) sex (male or female) (p = 0.12), where there were no statistically significant differences. Conclusions: The discovery of variations in pancreatic irrigation is common due to the numerous blood vessels involved in supplying this vital organ. Understanding different vascular patterns (such as those from the splenic and mesenteric arteries) is crucial for surgical interventions on the pancreas. For transplant patients, a thorough vascular analysis of both the donor and recipient is essential. Variations can impact blood flow and compatibility, potentially leading to transplant rejection if not addressed. To enhance outcomes, it is recommended to develop more accurate imaging tools for pre-surgical analysis, necessitating ongoing research in this area.
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Affiliation(s)
- Juan José Valenzuela-Fuenzalida
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile; (J.J.V.-F.); (C.I.N.-C.); (V.B.M.-D.); (P.N.-B.); (A.B.-M.)
| | - Camila Ignacia Núñez-Castro
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile; (J.J.V.-F.); (C.I.N.-C.); (V.B.M.-D.); (P.N.-B.); (A.B.-M.)
| | - Valeria Belén Morán-Durán
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile; (J.J.V.-F.); (C.I.N.-C.); (V.B.M.-D.); (P.N.-B.); (A.B.-M.)
| | - Pablo Nova-Baeza
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile; (J.J.V.-F.); (C.I.N.-C.); (V.B.M.-D.); (P.N.-B.); (A.B.-M.)
| | - Mathias Orellana-Donoso
- Escuela de Medicina, Universidad Finis Terrae, Santiago 7501015, Chile;
- Department of Morphological Sciences, Faculty of Medicine and Science, Universidad San Sebastián, Santiago 7510157, Chile
| | | | - Alvaro Becerra-Farfan
- Departamento de Ciencias Química y Biológicas, Facultad de Ciencias de la Salud, Universidad Bernardo O’Higgins, Santiago 8370993, Chile;
| | - Gustavo Oyanedel-Amaro
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Santiago 8910060, Chile;
| | - Alejandro Bruna-Mejias
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile; (J.J.V.-F.); (C.I.N.-C.); (V.B.M.-D.); (P.N.-B.); (A.B.-M.)
- Departamento de Ciencias y Geografía, Facultad de Ciencias Naturales y Exactas, Universidad de Playa Ancha, Valparaíso 2360072, Chile
| | - Guinevere Granite
- Department of Surgery, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, ML 20814, USA;
| | - Daniel Casanova-Martinez
- Facultad de Medicina, Universidad de Valparaíso, Campus San Felipe, Valparaíso 2170000, Chile;
- Laboratorio de Neuroanatomía Microquirúrgica (LaNeMic), Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires C1053, Argentina
| | - Juan Sanchis-Gimeno
- GIAVAL Research Group, Department of Anatomy and Human Embryology, Faculty of Medicine, University of Valencia, 46001 Valencia, Spain
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Ozdemir G, Olmez T, Dilek O, Eyi B, Sozutek A, Seker A. CT Angiography Assessment of Dorsal Pancreatic Artery and Intrapancreatic Arcade Anatomy: Impact on Whipple Surgery Outcomes. Tomography 2025; 11:9. [PMID: 39852689 PMCID: PMC11769064 DOI: 10.3390/tomography11010009] [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] [Received: 11/05/2024] [Revised: 12/28/2024] [Accepted: 01/09/2025] [Indexed: 01/26/2025] Open
Abstract
BACKGROUND/OBJECTIVES The aim was to investigate the association between variations in the dorsal pancreatic artery (DPA) and intrapancreatic arcade anatomy with Whipple procedure outcomes and postoperative complications. METHODS This retrospective study was conducted with 362 patients who underwent a Whipple procedure at the Department of Gastroenterological Surgery of Adana City Training and Research Hospital between January 2018 and April 2024. All data collected from medical records were compared and statistically analyzed according to the patients' survival status and arcade subtypes. RESULTS After excluding cases that did not meet the study criteria, a total of 284 patients were included in the study. DPA was visualized in 55.98% (159/284) of patients, while the intrapancreatic arcade was observed in 25% (71/284). The most common origin of the DPA was the splenic artery in 69.2% (n = 110) of patients, followed by the superior mesenteric artery in 17.6% (n = 28). The frequency of intrapancreatic arcade anatomy variations was as follows: type 1: 28.2% (n = 20), type 2: 49.3% (n = 35) and type 3: 22.5% (n = 16). Arcade type 4 anatomy was not detected. Postoperative pancreatic fistula (POPF) complication was found to be statistically significantly higher in patients with type 3 anatomy (p = 0.042). The 90-day mortality and long-term mortality rates did not differ among the groups based on the variations in both DPA and intrapancreatic arcade anatomy types. CONCLUSIONS Patients with intrapancreatic arcade type 3 anatomy had a higher risk of POPF complications. Determination of preoperative arcade type by computed tomography (CT) angiography may help to predict the risk of POPF.
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Affiliation(s)
- Gorkem Ozdemir
- Department of Gastroenterological Surgery, Adana City Training and Research Hospital, 01370 Adana, Turkey
| | - Tolga Olmez
- Department of Gastroenterological Surgery, Adana City Training and Research Hospital, 01370 Adana, Turkey
| | - Okan Dilek
- Department of Radiology, Adana City Training and Research Hospital, 01370 Adana, Turkey; (O.D.)
| | - Berkay Eyi
- Department of Radiology, Adana City Training and Research Hospital, 01370 Adana, Turkey; (O.D.)
| | - Alper Sozutek
- Department of Gastroenterological Surgery, Adana City Training and Research Hospital, 01370 Adana, Turkey
| | - Ahmet Seker
- Department of Gastroenterological Surgery, Adana City Training and Research Hospital, 01370 Adana, Turkey
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Kyuno T, Makino I, Kitagawa H, Terakawa H, Gabata R, Tokoro T, Takada S, Okazaki M, Nakanuma S, Ohta T, Yagi S. Morphology of the Dorsal Pancreatic Artery and Its Oncological Significance in Pancreatic Cancer. Pancreas 2024; 53:e513-e520. [PMID: 38530957 DOI: 10.1097/mpa.0000000000002327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
OBJECTIVES Although the dorsal pancreatic artery (DPA) is an important artery that supplies the pancreas, its morphology has not been sufficiently studied. We investigated the morphology of the DPA and the progression of pancreatic cancer along this vessel. MATERIALS AND METHODS Overall, 142 patients with pancreatic cancer who underwent surgical resection at Kanazawa University Hospital between 2004 and 2015 were enrolled. We examined the morphology of the DPA using preoperative computed tomography and cancer progression along the DPA using resected specimens. We investigated the anatomical structures surrounding the DPA through cadaveric examination. RESULTS The analysis of computed tomography images revealed the presence of the DPA in 141 patients. In typical cases, the DPA divides into a head and a body branch. Histopathological examination revealed cancer progression along the DPA in 32 patients. Cancer progression along the DPA was identified as a factor associated with a poor prognosis in pancreatic head or body cancer. Cadaveric examination showed the presence of abundant nerve and lymphatic tissues along the DPA. CONCLUSIONS It is important to remove the soft tissue surrounding the DPA during surgery for pancreatic head or body cancer because it may serve as an important route for cancer progression.
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Affiliation(s)
- Takahiro Kyuno
- From the Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University, Kanazawa
| | - Isamu Makino
- From the Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University, Kanazawa
| | | | | | - Ryosuke Gabata
- From the Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University, Kanazawa
| | - Tomokazu Tokoro
- From the Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University, Kanazawa
| | - Satoshi Takada
- From the Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University, Kanazawa
| | - Mitsuyoshi Okazaki
- From the Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University, Kanazawa
| | - Shinichi Nakanuma
- From the Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University, Kanazawa
| | - Tetsuo Ohta
- From the Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University, Kanazawa
| | - Shintaro Yagi
- From the Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University, Kanazawa
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Ho NX, Tingle SJ, Malik AK, Thompson ER, Kourounis G, Amer A, Pandanaboyana S, Wilson C, White S. Donor Blood Tests do Not Predict Pancreas Graft Survival After Simultaneous Pancreas Kidney Transplantation; a National Cohort Study. Transpl Int 2024; 37:12864. [PMID: 38832357 PMCID: PMC11144863 DOI: 10.3389/ti.2024.12864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 05/07/2024] [Indexed: 06/05/2024]
Abstract
Simultaneous pancreas-kidney (SPK) transplantation improves quality of life and limits progression of diabetic complications. There is reluctance to accept pancreata from donors with abnormal blood tests, due to concern of inferior outcomes. We investigated whether donor amylase and liver blood tests (markers of visceral ischaemic injury) predict pancreas graft outcome using the UK Transplant Registry (2016-2021). 857 SPK recipients were included (619 following brainstem death, 238 following circulatory death). Peak donor amylase ranged from 8 to 3300 U/L (median = 70), and this had no impact on pancreas graft survival when adjusting for multiple confounders (aHR = 0.944, 95% CI = 0.754-1.81). Peak alanine transaminases also did not influence pancreas graft survival in multivariable models (aHR = 0.967, 95% CI = 0.848-1.102). Restricted cubic splines were used to assess associations between donor blood tests and pancreas graft survival without assuming linear relationships; these confirmed neither amylase, nor transaminases, significantly impact pancreas transplant outcome. This is the largest, most statistically robust study evaluating donor blood tests and transplant outcome. Provided other factors are acceptable, pancreata from donors with mild or moderately raised amylase and transaminases can be accepted with confidence. The use of pancreas grafts from such donors is therefore a safe, immediate, and simple approach to expand the donor pool to reach increasing demands.
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Affiliation(s)
- Ning Xuan Ho
- National Institute for Health Research Blood and Transplant Research Unit (NIHR BTRU) in Organ Donation and Transplantation, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Samuel J. Tingle
- National Institute for Health Research Blood and Transplant Research Unit (NIHR BTRU) in Organ Donation and Transplantation, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Abdullah K. Malik
- National Institute for Health Research Blood and Transplant Research Unit (NIHR BTRU) in Organ Donation and Transplantation, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Emily R. Thompson
- National Institute for Health Research Blood and Transplant Research Unit (NIHR BTRU) in Organ Donation and Transplantation, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Georgios Kourounis
- National Institute for Health Research Blood and Transplant Research Unit (NIHR BTRU) in Organ Donation and Transplantation, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Aimen Amer
- National Institute for Health Research Blood and Transplant Research Unit (NIHR BTRU) in Organ Donation and Transplantation, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Sanjay Pandanaboyana
- National Institute for Health Research Blood and Transplant Research Unit (NIHR BTRU) in Organ Donation and Transplantation, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Colin Wilson
- National Institute for Health Research Blood and Transplant Research Unit (NIHR BTRU) in Organ Donation and Transplantation, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Steve White
- National Institute for Health Research Blood and Transplant Research Unit (NIHR BTRU) in Organ Donation and Transplantation, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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Rousek M, Kachlík D, Záruba P, Pudil J, Schütz ŠO, Balko J, Pohnán R. Vascular supply of postresection pancreatic remnant after pancreaticoduodenectomy: A cadaveric study. Medicine (Baltimore) 2023; 102:e35049. [PMID: 37682165 PMCID: PMC10489493 DOI: 10.1097/md.0000000000035049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/11/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVES The vascular supply to the neck and body of the pancreas is highly variable. The dorsal pancreatic artery is the dominant artery feeding this area. The aim of this study was to describe the vascular supply of postresection pancreatic remnants after pancreaticoduodenectomy. Patients with hazardous anatomical arrangement may be at a higher risk of postresection remnant ischemia and postoperative pancreatic fistula development. METHODS The modified Whipple procedure was performed on 20 cadaveric donors. The macroscopic anatomical supply of the postresection pancreatic remnant of each donor was evaluated. RESULTS The arterial supply of the postresection remnant was highly variable. In 30% of cases (6/20), the dorsal pancreatic artery was cut during the pancreatoduodenectomy or it was missing. In these cases, the area of the pancreaticojejunostomy construction was fed only through anastomoses between the transverse pancreatic artery and the pancreatic branches of the splenic artery. CONCLUSIONS In 30% of cases, the arterial supply of the postresection pancreatic remnant was dependent on inconstant intraparenchymal arterial anastomoses. These patients may be at a higher risk of postoperative pancreatic fistula development.
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Affiliation(s)
- Michael Rousek
- Department of Surgery, Second Faculty of Medicine of Charles University and Military University Hospital Prague, Praha, Czech Republic
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - David Kachlík
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Pavel Záruba
- Department of Surgery, Second Faculty of Medicine of Charles University and Military University Hospital Prague, Praha, Czech Republic
| | - Jiří Pudil
- Department of Surgery, Second Faculty of Medicine of Charles University and Military University Hospital Prague, Praha, Czech Republic
| | - Štěpán Ota Schütz
- Department of Surgery, Second Faculty of Medicine of Charles University and Military University Hospital Prague, Praha, Czech Republic
| | - Jan Balko
- Department of Pathology and Molecular Medicine, Second Faculty of Medicine, Charles University Prague and Faculty Hospital Motol, Prague, Czech Republic
| | - Radek Pohnán
- Department of Surgery, Second Faculty of Medicine of Charles University and Military University Hospital Prague, Praha, Czech Republic
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Yamane M, Ishikawa Y, Asano D, Watanabe S, Ueda H, Akahoshi K, Ono H, Kudo A, Tanaka S, Sugiyama Y, Muro S, Akita K, Tanabe M. Surgical anatomy of the dorsal pancreatic artery: Considering embryonic development. Pancreatology 2023; 23:697-703. [PMID: 37574438 DOI: 10.1016/j.pan.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/19/2023] [Accepted: 07/31/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVES The dorsal pancreatic artery (DPA) is a pancreatic branch with various anatomical variations. Previous studies mostly focused on the origin of the DPA, and its pathways and branching patterns have rarely been examined. The purpose of this study was to investigate the branching patterns and pathways of the DPA. METHODS This study included 110 patients who underwent computed tomography scans. We examined the pathways and branching patterns of the DPA. RESULTS The DPA was identified in 101 patients (92%), and originated from the splenic artery in 30 patients (31%), the common hepatic artery in 17 patients (17%), the celiac trunk in 10 patients (10%), the superior mesenteric artery in 27 patients (27%), the replaced right hepatic artery in 7 patients (7%), the inferior pancreaticoduodenal artery in 5 patients (5%), and other arteries in 3 patients (3%). Four distinct types of branches were identified as follows: the superior branch (32%), the inferior branch (86%), the right branch (80%), and the accessory middle colic artery (12%). Additionally, the arcs of Buhler and Riolan were observed in two patients each and their anastomotic vessels followed almost the same pathway as the DPA. CONCLUSION A number of variations of the DPA were observed with regard to its origin and branching pattern; however, the DPA and its branches always ran along the same pathway, as summarized in Fig. 4. The anatomical information gained from this study may contribute to performing safe pancreatic resections.
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Affiliation(s)
- Masahiro Yamane
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshiya Ishikawa
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Daisuke Asano
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shuichi Watanabe
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroki Ueda
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keiichi Akahoshi
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroaki Ono
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Atsushi Kudo
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shinji Tanaka
- Department of Molecular Oncology, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuzuki Sugiyama
- Department of Clinical Anatomy, Tokyo Medical and Dental University, Tokyo, Japan
| | - Satoru Muro
- Department of Clinical Anatomy, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keiichi Akita
- Department of Clinical Anatomy, Tokyo Medical and Dental University, Tokyo, Japan
| | - Minoru Tanabe
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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8
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Dmitriev I, Oganesyan M, Popova A, Orlov E, Sinelnikov M, Zharikov Y. Anatomical basis for pancreas transplantation via isolated splenic artery perfusion: A literature review. World J Clin Cases 2022; 10:12844-12853. [PMID: 36569006 PMCID: PMC9782932 DOI: 10.12998/wjcc.v10.i35.12844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/10/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022] Open
Abstract
The variability of vascular anatomy of the pancreas underlines the difficulty of its transplantation. Research regarding the consistency of anatomical variations shows splenic arterial dominance in most cases. This can significantly improve transplantation success. A systematic literature review was performed according to the quality standards described in the AMSTAR measurement tool and the PRISMA guidelines. We valuated existing literature regarding the vascularization and blood perfusion patterns of the pancreas in terms of dominance and variability. The collected data was independently analyzed by two researchers. Variance of vascular anatomy was seen to be underreported in literature, though significant findings have been included and discussed in this study, providing valuable insight into the dynamics of pancreatic perfusion and feasibility of transplantation on several different supplying arteries. The splenic artery (SA) has a high percentage of consistency in all found studies (over 90%). High frequency of anastomoses between arterial pools supplying the pancreas can mediate sufficient blood supply through a dominant vessel, such as the SA, which is present in most cases. Pancreatic transplantation with isolated SA blood supply can provide sufficient arterial perfusion of the pancreas for stable transplant viability due to high anatomical consistency of the SA and vast communications with other arterial systems.
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Affiliation(s)
- Ilya Dmitriev
- Department of Pancreas and Kidney Transplantation, N.V. Sklifosovsky Research Institute for Emergency Care, Moscow 107045, Russia
| | - Marine Oganesyan
- Department of Human Anatomy, Sechenov First Moscow State Medical University (Sechenov University), Moscow 125009, Russia
| | - Antonina Popova
- Department of Human Anatomy, Sechenov First Moscow State Medical University (Sechenov University), Moscow 125009, Russia
| | - Egor Orlov
- Department of Human Anatomy, Sechenov First Moscow State Medical University (Sechenov University), Moscow 125009, Russia
| | - Mikhail Sinelnikov
- Department of Human Anatomy, Sechenov First Moscow State Medical University (Sechenov University), Moscow 125009, Russia
- Department of Oncology, Radiotherapy and Reconstructive Surgery, Sechenov First Moscow State Medical University (Sechenov University), Moscow 119048, Russia
- Laboratory of clinical morphology, Research Institute of Human Morphology, Moscow 117418, Russia
| | - Yury Zharikov
- Department of Human Anatomy, Sechenov First Moscow State Medical University (Sechenov University), Moscow 125009, Russia
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9
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Rousek M, Whitley A, Kachlík D, Balko J, Záruba P, Belbl M, Nikov A, Ryska M, Gürlich R, Pohnán R. The dorsal pancreatic artery: A meta-analysis with clinical correlations. Pancreatology 2022; 22:325-332. [PMID: 35177332 DOI: 10.1016/j.pan.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/09/2022] [Accepted: 02/09/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES The dorsal pancreatic artery is the main artery of the body and tail of the pancreas. Its origin and branching is highly variable. The aim of this study was to perform a meta-analysis to generate pooled prevalence data on the presence and origin of the dorsal pancreatic artery. Clinically important aspects of the dorsal pancreatic artery were summarised during the literature review. METHODS Major medical databases were searched. Data on the presence and point of origin of the dorsal pancreatic artery were extracted and quantitatively synthesised. The obtained data of anatomical based studies and computed tomography based studies were statistically analysed. RESULTS In total, 30 studies, comprising 2322 anatomical and computed tomography based cases were included. The dorsal pancreatic artery was present in 95.8% of cases. It originated from the splenic artery in 37.6% of cases, common hepatic artery in 18.3% of cases, coeliac trunk in 11.9% of cases and the superior mesenteric artery in 23.9% of cases. Other rare origins were present in 2.77% of cases. Multiple dorsal pancreatic arteries were found in 1,7% of cases. There was no significant difference in the presence or origin of the dorsal pancreatic artery between anatomical and computed tomography based studies. CONCLUSION The dorsal pancreatic artery is present in the vast majority of cases. Its origin and branching are highly variable. Multiplicity of the dorsal pancreatic artery is infrequent.
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Affiliation(s)
- Michael Rousek
- Department of Surgery, Second Faculty of Medicine of Charles University and Military University Hospital, Prague, Czech Republic.
| | - Adam Whitley
- Department of Surgery, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic; Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - David Kachlík
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jan Balko
- Department of Pathology and Molecular Medicine, Second Faculty of Medicine, Charles University Prague and Faculty Hospital Motol, Czech Republic
| | - Pavel Záruba
- Department of Surgery, Second Faculty of Medicine of Charles University and Military University Hospital, Prague, Czech Republic
| | - Miroslav Belbl
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Andrej Nikov
- Department of Surgery, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Miroslav Ryska
- Department of Surgery, Second Faculty of Medicine of Charles University and Military University Hospital, Prague, Czech Republic
| | - Robert Gürlich
- Department of Surgery, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Radek Pohnán
- Department of Surgery, Second Faculty of Medicine of Charles University and Military University Hospital, Prague, Czech Republic
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10
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Laface C, Laforgia M, Molinari P, Foti C, Ambrogio F, Gadaleta CD, Ranieri G. Intra-Arterial Infusion Chemotherapy in Advanced Pancreatic Cancer: A Comprehensive Review. Cancers (Basel) 2022; 14:cancers14020450. [PMID: 35053614 PMCID: PMC8774130 DOI: 10.3390/cancers14020450] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Pancreatic cancer has a very poor prognosis. The few available therapeutic options are characterized by low efficacy and high toxicity due to the intrinsic chemoresistance of this tumor type. To improve clinical results, some clinical trials have evaluated regional chemotherapy as a treatment option for PC. The pancreatic arterial infusion of chemotherapeutics has the aim of obtaining higher local concentrations of drugs and, at the same time, of limiting systemic toxicity. This therapeutic approach has already been successfully evaluated for the treatment of several types of tumors. Regarding advanced pancreatic cancers, only a few clinical studies have investigated the safety and efficacy of this treatment, with very promising results. Therefore, in this review, we summarize literature data on the clinical approaches to pancreatic arterial drug administration for the treatment of advanced PC to deepen knowledge on this topic. Abstract Advanced pancreatic cancer (PC) has a very poor prognosis due to its chemoresistant nature. Nowadays, only a few therapeutic options are available for PC, and the most effective ones are characterized by low response rates (RRs), short progression-free survival and overall survival, and severe toxicity. To improve clinical results, small series studies have evaluated loco-regional chemotherapy as a treatment option for PC, demonstrating its dose-dependent sensitivity towards the tumor. In fact, pancreatic arterial infusion (PAI) chemotherapy allows higher local concentrations of chemotherapeutic agents, sparing healthy tissues with a lower rate of adverse events compared to systemic chemotherapy. This therapeutic approach has already been evaluated in different types of tumors, especially in primary and metastatic liver cancers, with favourable results. With regard to advanced PC, a few clinical studies have investigated the safety and efficacy of PAI with promising results, especially in terms of RRs compared to systemic chemotherapy. However, clear evidence about its efficacy has not been established yet nor have the underlying mechanisms leading to its success. In this review, we aim to summarize the literature data on the clinical approaches to pancreatic arterial drug administration in terms of techniques, drug pharmacokinetics, and clinical outcomes for advanced PC.
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Affiliation(s)
- Carmelo Laface
- Interventional and Medical Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy; (C.L.); (P.M.); (C.D.G.)
- Department of Biomedical Sciences and Clinical Oncology, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Mariarita Laforgia
- Pharmacy Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy;
| | - Pasquale Molinari
- Interventional and Medical Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy; (C.L.); (P.M.); (C.D.G.)
| | - Caterina Foti
- Department of Biomedical Science and Human Oncology, Dermatological Clinic, University of Bari Aldo Moro, 70124 Bari, Italy; (C.F.); (F.A.)
| | - Francesca Ambrogio
- Department of Biomedical Science and Human Oncology, Dermatological Clinic, University of Bari Aldo Moro, 70124 Bari, Italy; (C.F.); (F.A.)
| | - Cosmo Damiano Gadaleta
- Interventional and Medical Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy; (C.L.); (P.M.); (C.D.G.)
| | - Girolamo Ranieri
- Interventional and Medical Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy; (C.L.); (P.M.); (C.D.G.)
- Correspondence:
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11
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Cienfuegos JA, Hurtado-Pardo L, Benito A, Rotellar F. Site of pancreatic resection and pancreatic fistula in distal pancreatectomy: What are we leaving behind? Pancreatology 2021; 21:835-836. [PMID: 33766483 DOI: 10.1016/j.pan.2021.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/14/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Javier A Cienfuegos
- Department of General Surgery. Clínica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain; Institute of Health Research of Navarra (IdisNA), Pamplona, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 31008, Pamplona, Spain.
| | - Luis Hurtado-Pardo
- Department of General Surgery, University and Polytechnic La Fe Hospital, Valencia, Spain
| | - Alberto Benito
- Department of Radiology. Clínica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - Fernando Rotellar
- Department of General Surgery. Clínica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain; Institute of Health Research of Navarra (IdisNA), Pamplona, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 31008, Pamplona, Spain
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12
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Controlling the arterial supply into the pancreatic head region as a whole peripancreatic arterial arcade via a mesenteric approach during isolated pancreatoduodenectomy. Surg Today 2021; 51:1819-1827. [PMID: 34014389 DOI: 10.1007/s00595-021-02298-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 02/28/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The peripancreatic arterial system forms various arterial arcades and collateral branches; therefore, it stands to reason that the arterial supply into the pancreatic head region should be controlled as a whole peripancreatic arterial arcade rather than as the three major supplying arteries during isolated pancreatoduodenectomy (PD). We investigated the clinical importance of early control of the whole peripancreatic arterial arcade during PD. METHODS The subjects of this retrospective study were 63 consecutive patients who underwent PD via a mesenteric approach at our hospital between October, 2014 and February, 2017. The patients were divided into an early control group (n = 27) and a late control group (n = 36) for comparative analysis. RESULTS The peripancreatic arterial arcades and collateral branches were seen on preoperative multidetector row computed tomography (CT) images and during PD in all 63 patients. The early control group had significantly less intraoperative blood loss than the late control group. Early control of the whole peripancreatic arterial arcade was an independent factor associated with lower intraoperative blood loss in the multivariable analysis (P = 0.012). CONCLUSION The arterial supply into the pancreatic head region should be controlled as a whole peripancreatic arterial arcade rather than as the three major supplying arteries during isolated PD.
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13
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Habash M, Ceballos D, Gunn AJ. Splenic Artery Embolization for Patients with High-Grade Splenic Trauma: Indications, Techniques, and Clinical Outcomes. Semin Intervent Radiol 2021; 38:105-112. [PMID: 33883807 DOI: 10.1055/s-0041-1724010] [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: 10/21/2022]
Abstract
The spleen is the most commonly injured organ in blunt abdominal trauma. Patients who are hemodynamically unstable due to splenic trauma undergo definitive operative management. Interventional radiology plays an important role in the multidisciplinary management of the hemodynamically stable trauma patient with splenic injury. Hemodynamically stable patients selected for nonoperative management have improved clinical outcomes when splenic artery embolization is utilized. The purpose of this article is to review the indications, technical aspects, and clinical outcomes of splenic artery embolization for patients with high-grade splenic injuries.
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Affiliation(s)
- Majd Habash
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Darrel Ceballos
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Andrew J Gunn
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
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14
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Evaluation of relationship between splenic artery and pancreatic parenchyma using three-dimensional computed tomography for laparoscopic distal pancreatectomy. Langenbecks Arch Surg 2021; 406:1885-1892. [PMID: 33721087 DOI: 10.1007/s00423-021-02101-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/21/2021] [Indexed: 01/06/2023]
Abstract
AIM Isolating the root of the splenic artery (SPA) is a challenging procedure in laparoscopic distal pancreatectomy (LDP). We investigated the usefulness of evaluation of the relationship between the SPA and pancreatic parenchyma using three-dimensional computed tomography (3D-CT). METHODS In total, 104 patients were evaluated. The relationship between the SPA and pancreatic parenchyma was classified into two types: buried and non-buried. Video clips of 50 patients who underwent LDP requiring isolation of the SPA root were reviewed to determine whether the classification is related to difficulty of LDP. RESULTS Of the 50 assessed patients who underwent LDP, the relationship between the SPA and pancreatic parenchyma was the buried type in 30 (60.0%) and non-buried type in 20 (40.0%). The buried type was associated with a significantly longer median operative time than the non-buried type (285.0 vs. 235.5 min, respectively; P < 0.01). The median time required to isolate the SPA in the buried type (25.8 min; range, 4.0-101 min) was significantly longer than that in the non-buried type (7.0 min; range, 1.0-27.0 min) (P < 0.001). CONCLUSION Preoperative 3D-CT around the pancreas is practical for predicting the difficulty of SPA isolation and determining the safety of the procedure.
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15
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Kumar KH, Garg S, Yadav TD, Sahni D, Singh H, Singh R. Anatomy of peripancreatic arteries and pancreaticoduodenal arterial arcades in the human pancreas: a cadaveric study. Surg Radiol Anat 2021; 43:367-375. [PMID: 33392701 DOI: 10.1007/s00276-020-02632-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 11/17/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The purpose of this work was to evaluate the arteries supplying the pancreaticoduodenal (PD) complex. MATERIALS AND METHODS The study was conducted on 15 fresh enbloc pancreatic specimens by latex injection method which enabled the visualization of the peripancreatic arteries and their minute branches. RESULTS The gastroduodenal (GDA), anterior superior pancreaticoduodenal (ASPD), and anterior inferior pancreaticoduodenal (AIPD) artery was found in all the cases, whereas the posterior superior pancreaticoduodenal (PSPD) and posterior inferior pancreaticoduodenal (PIPD) artery was present in 93.34% cases. The ASPD artery originated from GDA in all the cases. Two types of variations were observed in the origin of PSPD artery and four types each in the origin of AIPD and PIPD artery. Anatomical and numerical variations were observed in both anterior and posterior arches, posterior arch being absent in 20% cases. CONCLUSIONS In the present study, an attempt was made to systematically describe the individual arterial configurations of the PD complex. The information provided here has important implications for preoperative planning of technically challenging surgeries and interventions around the pancreatic head.
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Affiliation(s)
- K Hemanth Kumar
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Shallu Garg
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Thakur Deen Yadav
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Daisy Sahni
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harsimranjit Singh
- Department of Anatomy, All India Institute of Medical Sciences, Bathinda, India
| | - Rajinder Singh
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
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16
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Essentials of Insulinoma Localization with Selective Arterial Calcium Stimulation and Hepatic Venous Sampling. J Clin Med 2020; 9:jcm9103091. [PMID: 32992761 PMCID: PMC7601191 DOI: 10.3390/jcm9103091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/19/2020] [Accepted: 09/21/2020] [Indexed: 12/25/2022] Open
Abstract
Insulinomas are the most common functional pancreatic neuroendocrine tumor. Most insulinomas can be localized non-invasively with cross-sectional and nuclear imaging. Selective arterial calcium stimulation and hepatic venous sampling is an effective and safe minimally-invasive procedure for insulinoma localization that may be utilized when non-invasive techniques are inconclusive. The procedure’s technical success and proper interpretation of its results is dependent on the interventional radiologist’s knowledge of normal and variant pancreatic arterial perfusion. Accurate pre-operative localization aids in successful surgical resection. Technical and anatomic considerations of insulinoma localization with selective arterial calcium stimulation and hepatic venous sampling are reviewed.
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17
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Tatsuoka T, Noie T, Noro T, Nakata M, Yamada H, Harihara Y. Dorsal Pancreatic Artery—a Study of Its Detailed Anatomy for Safe Pancreaticoduodenectomy. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02255-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
AbstractEarly division of the dorsal pancreatic artery (DPA) or its branches to the uncinate process during pancreaticoduodenectomy (PD) in addition to early division of the gastroduodenal artery and inferior pancreaticoduodenal artery should be performed to reduce blood loss by completely avoiding venous congestion. However, the significance of early division of DPA or its branches to the uncinate process has not been reported. The aim of this study was to investigate the anatomy of DPA and its branches to the uncinate process using the currently available high-resolution dynamic computed tomography (CT) as the first step to investigate the significance of DPA in the artery-first approach during PD. Preoperative dynamic thin-slice CT data of 160 consecutive patients who underwent hepato–pancreato–biliary surgery were examined focusing on the anatomy of DPA and its branches to the uncinate process. DPA was recognized in 103 patients (64%); it originated from the celiac axis or its branches in 70 patients and from the superior mesenteric artery or its branches in 34 patients. The branches to the uncinate process were visualized in 82 patients (80% of those with DPA), with diameters of 0.5–1.5 mm in approximately 80% of the 82 patients irrespective of DPA origin. DPA branches to the uncinate process were recognized using high-resolution CT in approximately half of the patients.
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18
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The anatomical features of dorsal pancreatic artery in the pancreatic head and its clinical significance in laparoscopic pancreatoduodenectomy. Surg Endosc 2020; 35:569-575. [DOI: 10.1007/s00464-020-07417-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/10/2020] [Indexed: 12/19/2022]
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Ito K, Takemura N, Inagaki F, Mihara F, Kurokawa T, Kokudo N. Arterial blood supply to the pancreas from accessary middle colic artery. Pancreatology 2019; 19:781-785. [PMID: 31164320 DOI: 10.1016/j.pan.2019.05.458] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/17/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND An accessory middle colic artery (AMCA) is an aberrant artery feeding the splenic flexure of the colon. Little is known about the branching pattern of an AMCA. We aimed to evaluate the branching pattern of the AMCA from the superior mesenteric artery (SMA) with special reference to the pancreatic artery using multidetector-row computed tomography (MDCT) before surgery. METHODS We investigated 112 patients who underwent contrast-enhancement MDCT before surgical resection of the pancreas between January 2015 and July 2018. The pancreatic branch from the AMCA was divided into the dorsal pancreatic artery (DPA) and the inferior pancreaticoduodenal artery (IPDA). The branching level and angle of the AMCA from the SMA were also evaluated. RESULTS The AMCA was present in 27.7% of patients (n = 31/112). The AMCA branching pattern was classified into four types: type A, no branch from the AMCA (n = 20); type B, a common trunk with the DPA (n = 6); type C, a common trunk with the IPDA (n = 3); and type D, a common trunk with the DPA and IPDA (n = 2). The AMCA with the IPDA (types C and D) branched more proximally compared to the AMCA without the IPDA (P = 0.04). The AMCA branched vertically from the SMA in most cases (n = 24/31, 77.4%). CONCLUSIONS The AMCA had a pancreatic branch in 8.9% (10/112) of cases. Special attention should be paid to its branching pattern in pancreatic and colon surgery.
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Affiliation(s)
- Kyoji Ito
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Nobuyuki Takemura
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Fuyuki Inagaki
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Fuminori Mihara
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Toshiaki Kurokawa
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Norihiro Kokudo
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.
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Covantev S, Mazuruc N, Belic O. The Arterial Supply of the Distal Part of the Pancreas. Surg Res Pract 2019; 2019:5804047. [PMID: 31016226 PMCID: PMC6446113 DOI: 10.1155/2019/5804047] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 02/25/2019] [Indexed: 12/14/2022] Open
Abstract
The pancreatic surgery field has evolved greatly over the previous years. Nevertheless, the vascularization of the pancreas remains a difficult subject and requires further attention. The study was conducted using macroscopical dissection and corrosion cast methods. The total number of organ blocks was 72 (50 for dissection and 22 for corrosion cast). Based on the data obtained by dissection, we can distinguish three major types of vascularization of the distal pancreas. In type one, the pancreas was vascularized only by the short branches of the splenic artery and was encountered in 18 cases (36%). In type two, the pancreas was vascularized by the long and short branches of the splenic artery and was encountered in 20 cases (40%). In type three, the pancreas was vascularized only by the long branches of the splenic artery in 12 cases (24%). Compared to that, the corrosion cast method demonstrated type 1 in 8 cases (36.36%), type 2 in 10 cases (45.46%), and type 3 in 4 cases (18.18%). During the dissection, there were no arteries to the tail of the pancreas in 13 (26%) cases, one artery in 15 (30%) cases, two arteries in 19 (38%), and three arteries in three (6%) cases. The 22 corrosion cast specimens were also evaluated based on the classification of Roman Ramos and coworkers. Type I (small arcades) was in 9 (40.90%) cases, type II (small and large arcades) was in 7 (31.82%) cases, type III (large arcades) was in 5 (22.73%) cases, and type IV (straight branches) was in 1 (4.55%) case. The corrosion cast method allowed us to determine no arteries to the tail in 4 (18.18%) cases, one artery in 6 (27.27%) cases, two arteries in 10 (45.46%) cases and three arteries in two (9.09%) cases. The vascularization of the distal part of the pancreas is highly variable and should be taken into consideration during surgery.
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Affiliation(s)
- S. Covantev
- Laboratory of Allergology and Clinical Immunology, State University of Medicine and Pharmacy “Nicolae Testemitanu”, Chisinau, Moldova
| | - N. Mazuruc
- Department of Human Anatomy, State University of Medicine and Pharmacy “Nicolae Testemitanu”, Chisinau, Moldova
| | - O. Belic
- Department of Human Anatomy, State University of Medicine and Pharmacy “Nicolae Testemitanu”, Chisinau, Moldova
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Quencer KB, Smith TA. Review of proximal splenic artery embolization in blunt abdominal trauma. CVIR Endovasc 2019; 2:11. [PMID: 32026033 PMCID: PMC7224246 DOI: 10.1186/s42155-019-0055-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/07/2019] [Indexed: 11/11/2022] Open
Abstract
The spleen is the most commonly injured organ in blunt abdominal trauma. Unstable patients undergo laparotomy and splenectomy. Stable patients with lower grade injuries are treated conservatively; those stable patients with moderate to severe splenic injuries (grade III-V) benefit from endovascular splenic artery embolization. Two widely used embolization approaches are proximal and distal splenic artery embolization. Proximal splenic artery embolization decreases the perfusion pressure in the spleen but allows for viability of the spleen to be maintained via collateral pathways. Distal embolization can be used in cases of focal injury. In this article we review relevant literature on splenic embolization indication, and technique, comparing and contrasting proximal and distal embolization. Additionally, we review relevant anatomy and discuss collateral perfusion pathways following proximal embolization. Finally, we review potential complications of splenic artery embolization.
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Affiliation(s)
- Keith Bertram Quencer
- Division of Interventional Radiology, University of Utah Department of Radiology, 30 N. 1900 E., Salt Lake City, UT, 84132, USA
| | - Tyler Andrew Smith
- Division of Interventional Radiology, University of Utah Department of Radiology, 30 N. 1900 E., Salt Lake City, UT, 84132, USA.
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22
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Iede K, Nakao A, Oshima K, Suzuki R, Yamada H, Oshima Y, Kobayashi H, Kimura Y. Early ligation of the dorsal pancreatic artery with a mesenteric approach reduces intraoperative blood loss during pancreatoduodenectomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2018; 25:329-334. [PMID: 29747222 DOI: 10.1002/jhbp.562] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Early ligation of the inferior pancreatoduodenal artery has been advocated to reduce blood loss during pancreatoduodenectomy. However, the impact of early ligation of the dorsal pancreatic artery (DPA) remains unclear. This study was performed to investigate the clinical implications of early ligation of the DPA. METHODS From October 2014 to April 2017, 34 consecutive patients underwent pancreatoduodenectomy using a mesenteric approach. The patients were divided into the early DPA ligation group (n = 15) and late DPA ligation group (n = 19). The clinical features were retrospectively compared between the two groups (H29-044). RESULTS Preoperative multidetector row computed tomography and intraoperative findings revealed that the right branch of the DPA supplied the pancreatic head region in all cases. Intraoperative blood loss was significantly lower in the early than late ligation group (median 609 ml [range 94-1,013 ml] vs. 764 ml [range 367-1,828 ml], respectively; P = 0.008). Multivariable analysis revealed that early DPA ligation was independently associated with blood loss (P = 0.023). The DPAs arising from the superior mesenteric artery underwent early ligation at a significantly higher rate. CONCLUSIONS Early ligation of the DPA during pancreaticoduodenectomy with a mesenteric approach could reduce intraoperative blood loss.
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Affiliation(s)
- Kiyotsugu Iede
- Department of Surgery, Nagoya Central Hospital, 3-7-7 Taiko, Nakamura-ku, Nagoya, 453-0801, Japan
| | - Akimasa Nakao
- Department of Surgery, Nagoya Central Hospital, 3-7-7 Taiko, Nakamura-ku, Nagoya, 453-0801, Japan
| | - Kenji Oshima
- Department of Surgery, Nagoya Central Hospital, 3-7-7 Taiko, Nakamura-ku, Nagoya, 453-0801, Japan
| | - Ryota Suzuki
- Department of Surgery, Nagoya Central Hospital, 3-7-7 Taiko, Nakamura-ku, Nagoya, 453-0801, Japan
| | - Hironori Yamada
- Department of Surgery, Nagoya Central Hospital, 3-7-7 Taiko, Nakamura-ku, Nagoya, 453-0801, Japan
| | - Yukiko Oshima
- Department of Surgery, Nagoya Central Hospital, 3-7-7 Taiko, Nakamura-ku, Nagoya, 453-0801, Japan
| | - Hironobu Kobayashi
- Department of Surgery, Nagoya Central Hospital, 3-7-7 Taiko, Nakamura-ku, Nagoya, 453-0801, Japan
| | - Yasunori Kimura
- Department of Surgery, Nagoya Central Hospital, 3-7-7 Taiko, Nakamura-ku, Nagoya, 453-0801, Japan
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Macchi V, Picardi EEE, Porzionato A, Morra A, Bardini R, Loukas M, Tubbs RS, De Caro R. Anatomo-radiological patterns of pancreatic vascularization, with surgical implications: Clinical and anatomical study. Clin Anat 2017; 30:614-624. [PMID: 28395109 DOI: 10.1002/ca.22885] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 03/25/2017] [Accepted: 04/04/2017] [Indexed: 12/14/2022]
Abstract
The pancreas receives multiple arterial sources that should be considered in patients undergoing pancreatic surgery. The aim of this study is to describe pancreatic vascularization and to explore the anatomical basis of postoperative complications. Ten specimens from unembalmed cadavers, including the retroperitoneal vessels and organs and spleen, were injected with acrylic resins to obtain vascular casts. Thirty computed tomography angiographies (CTA) of subjects with no pancreatic pathology (mean age 70.9 years) were also analyzed. A paucivascular area at the neck of the pancreas was apparent in all vascular casts. At CTA: (1) the transverse pancreatic artery, the only artery running from the cervicocephalic to the somatocaudal segment, was visible in 76.9% of cases; (2) the splenic artery was suprapancreatic in 66.7% and intrapancreatic with a tortuous course in 33.3%; (3) the posterior superior pancreaticoduodenal artery was visible in 100% of cases, the anterior superior pancreatico-duodenal artery in 92.6%, the anterior inferior pancreaticoduodenal artery in 73.1%, the posterior inferior pancreaticoduodenal artery in 86.4%, the dorsal pancreatic artery in 65.4%, the great pancreatic artery in 73.1%, and the pancreatic arteries to the body and caudal pancreatic arteries in 96.2%. Our study demonstrated great individual variability of the pancreatic vasculature, which can be explored by CTA and could be relevant to surgical procedures. Clin. Anat. 30:614-624, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Veronica Macchi
- Department of Neurosciences, University of Padova, Institute of Human Anatomy, Padova, Italy
| | | | - Andrea Porzionato
- Department of Neurosciences, University of Padova, Institute of Human Anatomy, Padova, Italy
| | - Aldo Morra
- Section of Radiology, Euganea Medica Center, Padova, Italy
| | - Romeo Bardini
- UOC General Surgery, Department of Surgical, Oncological and Gastroenterological sciences, University of Padova, Padova, Italy
| | - Marios Loukas
- Department of Anatomical Sciences, School of Medicine, St. George's University, West Indies, Grenada
| | | | - Raffaele De Caro
- Department of Neurosciences, University of Padova, Institute of Human Anatomy, Padova, Italy
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Ozaki K, Kobayashi S, Matsui O, Minami T, Koda W, Gabata T. Extrahepatic Arteries Originating from Hepatic Arteries: Analysis Using CT During Hepatic Arteriography and Visualization on Digital Subtraction Angiography. Cardiovasc Intervent Radiol 2017; 40:822-830. [PMID: 28083645 DOI: 10.1007/s00270-017-1568-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 01/02/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate the prevalence and site of origin of extrahepatic arteries originating from hepatic arteries on early phase CT during hepatic arteriography (CTHA) was accessed. Visualization of these elements on digital subtraction hepatic angiography (DSHA) was assessed using CTHA images as a gold standard. MATERIALS AND METHODS A total of 943 patients (mean age 66.9 ± 10.3 years; male/female, 619/324) underwent CTHA and DSHA. The prevalence and site of origin of extrahepatic arteries were accessed using CTHA and visualized using DSHA. RESULTS In 924 (98.0%) patients, a total of 1555 extrahepatic branches, representing eight types, were found to originate from hepatic arteries on CTHA. CTHA indicated the following extrahepatic branch prevalence rates: right gastric artery, 890 (94.4%); falciform artery, 386 (40.9%); accessory left gastric artery, 161 (17.1%); left inferior phrenic artery (IPA), 43 (4.6%); posterior superior pancreaticoduodenal artery, 33 (3.5%); dorsal pancreatic artery, 26 (2.8%); duodenal artery, 12 (1.3%); and right IPA, 4 (0.4%). In addition, 383 patients (40.6%) had at least one undetectable branch on DSHA. The sensitivity, specificity, and accuracy of visualization on DSHA were as follows: RGA, 80.0, 86.8, and 80.4%; falciform artery, 53.9, 97.7, and 80.0%; accessory LGA, 64.6, 98.6, and 92.3%; left IPA, 76.7, 99.8, and 98.7%; PSPDA, 100, 99.7, and 99.9%; dorsal pancreatic artery, 57.7, 100, and 98.8%; duodenal artery, 8.3, 99.9, and 98.7%; and right IPA, 0, 100, and 99.6%, respectively. CONCLUSION Extrahepatic arteries originating from hepatic arteries were frequently identified on CTHA images. These arteries were frequently overlooked on DSHA.
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Affiliation(s)
- Kumi Ozaki
- Department of Radiology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, 920-8640, Japan.
| | - Satoshi Kobayashi
- Department of Quantum Medicine Technology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Osamu Matsui
- Department of Radiology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, 920-8640, Japan
| | - Tetsuya Minami
- Department of Radiology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, 920-8640, Japan
| | - Wataru Koda
- Department of Radiology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, 920-8640, Japan
| | - Toshifumi Gabata
- Department of Radiology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, 920-8640, Japan
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Baranski AG, Lam HD, Braat AE, Schaapherder AF. The dorsal pancreatic artery in pancreas procurement and transplantation: anatomical considerations and potential implications. Clin Transplant 2016; 30:1360-1364. [PMID: 27555344 DOI: 10.1111/ctr.12814] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2016] [Indexed: 12/14/2022]
Abstract
AIM Organ procurement errors account for almost 20% of discarded pancreatic allografts. For this reason, the anatomical significance of the dorsal pancreatic artery (DPA) was reviewed. METHODS A strategy on dealing with an often overlooked DPA is evaluated. RESULTS The DPA provides together with the splenic artery the main blood supply to the pancreatic tail. Three different arterial variations have been described. In the rare instances when the DPA arises from the common hepatic artery or the celiac trunk, instead of the splenic origin, the DPA can easily be overlooked by surgeons not familiar with this artery. This may result in an unintentional damage to the pancreatic tail blood supply. If unrecognized during the back-table inspection, it could potentially jeopardize the pancreatic graft after reperfusion. When a cut DPA is encountered during inspection, efforts should be attempted to revascularize the graft, especially if there is no backflow from the splenic artery as sign of absent collateral circulation. CONCLUSION The DPA may play a more prominent role in the vascularization of pancreas transplants than currently assumed. Better understanding of the vascular anatomy may lead to improved results in pancreas transplantation.
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Affiliation(s)
- André G Baranski
- Department of Transplantation Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | - Hwai-Ding Lam
- Department of Transplantation Surgery, Leiden University Medical Centre, Leiden, Netherlands.
| | - Andries E Braat
- Department of Transplantation Surgery, Leiden University Medical Centre, Leiden, Netherlands
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Shi YJ, Zhang XP, Sun YS, Qi LP, Li Y, Zhu HB, Li XT, Zhang XY. Spectral CT in the Demonstration of the Pancreatic Arteries and Their Branches: A Comparison With Conventional CT. Medicine (Baltimore) 2016; 95:e2823. [PMID: 26886636 PMCID: PMC4998636 DOI: 10.1097/md.0000000000002823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The aim of this study was to investigate the performance of monochromatic images of spectral computed tomographic (CT) in the visualization of the pancreatic arteries compared with polychromatic CT images. We conducted a case-control study in a group of 26 consecutive patients with monochromatic CT and contrasted the results against a control group of 26 consecutive patients with polychromatic CT. The CNR (contrast-to-noise ratio), SIR (signal intensity ratio), SNR (signal to noise ratio), and image noise were measured. A 5-score classification system was used to evaluate the branch order of pancreatic arteries. The course of pancreatic arteries was compared. Compared with polychromatic images, the CNR, SIR, and SNR obtained by monochromatic images were increased by 64.74%, 23.99%, and 39.50%. Branch visualization of PSPDA (posterior superior pancreaticoduodenal artery), ASPDA (anterior superior pancreaticoduodenal artery), and DPA (dorsal pancreatic artery) was better at monochromatic images than at polychromatic images. The display rate was significantly better in monochromatic images for the second and third segments of PSPDA, total course of ASPDA, and artery of uncinate process. Compared with polychromatic images, monochromatic images can improve the visualization of pancreatic arteries.
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Affiliation(s)
- Yan-Jie Shi
- From the Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing, China
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Hagiwara A, Akai H, Kosaka T, Suyama Y, Ogura K, Kawauchi N. A Dorsal Pancreatic Artery Originating from the Right Inferior Phrenic Artery. J Vasc Interv Radiol 2016; 27:143-5. [DOI: 10.1016/j.jvir.2015.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 06/03/2015] [Indexed: 11/29/2022] Open
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Thompson SM, Vella A, Service FJ, Grant CS, Thompson GB, Andrews JC. Impact of variant pancreatic arterial anatomy and overlap in regional perfusion on the interpretation of selective arterial calcium stimulation with hepatic venous sampling for preoperative localization of occult insulinoma. Surgery 2015; 158:162-72. [PMID: 25873534 DOI: 10.1016/j.surg.2015.03.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 02/25/2015] [Accepted: 03/07/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND To determine the impact of variant pancreatic arterial anatomy and overlap in regional perfusion on the interpretation of selective arterial calcium stimulation (SACST) with hepatic venous sampling for preoperative localization of occult insulinoma. METHODS An institutional review board-approved retrospective review was undertaken of 42 patients with surgically confirmed, occult insulinoma who underwent SACST from January 1996 to March 2014. Location of the insulinoma was predicted initially based on the biochemical results of SACST alone according to Doppman's criteria. Pancreatic arteriograms were reviewed blinded to the biochemical results and the regional perfusion of each artery assessed. The anatomic and perfusion data were combined with the biochemical results to make a second prediction and compared with the surgical findings. RESULTS The biochemical results were positive in 1, 2, and 3 arterial distributions in 73.8%, 21.4%, and 4.8% of patients, respectively. The celiac trunk and superior mesenteric artery (SMA) anatomy were aberrant in 38.1% and 35.7% of patients, respectively. Clinically significant variations included dorsal pancreatic artery replaced to SMA (21.4%) and celiac stenosis (4.8%). Significant variation and overlap in regional pancreatic perfusion was observed, particularly for the SMA. Sensitivity for insulinoma localization was 54.8% (diagnostic arteriography), 73.8% (biochemical data), 88.1% (biochemical, anatomic, perfusion data), and 92.8% (arteriographic, biochemical, anatomic, perfusion data). CONCLUSION Careful review of the pancreatic arterial anatomy and regional perfusion is critical for correct interpretation of the biochemical results of SACST and improves the sensitivity of localization for occult insulinoma, particularly in the presence of pancreatic arterial variants or overlap in regional perfusion.
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29
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Yin T, Wan Z, Chen H, Mao X, Yi Y, Li D. Obstructive jaundice caused by pancreaticoduodenal artery aneurysms associated with celiac axis stenosis: case report and review of the literature. Ann Vasc Surg 2015; 29:1016.e1-6. [PMID: 25769284 DOI: 10.1016/j.avsg.2014.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 11/20/2014] [Accepted: 12/14/2014] [Indexed: 10/23/2022]
Abstract
Pancreaticoduodenal artery aneurysm (PDA) is quite rare, which accounts for only approximate 2% of all visceral aneurysms. Besides, PDA is usually related to celiac axis stenosis (CAS) and prone to rupture. Advanced imaging examination can facilitate the disclosure of such peripancreatic masses, but most of them were seldom diagnosed until they rupture because of the nonspecific symptoms. Secondary to PDA, obstructive jaundice is however an extremely rare manifestation. A case of an 84-year-old man is reported here, who suffered from severe jaundice caused by a ruptured PDA associated with CAS. In addition, this review collects and organizes PDAs with jaundice by applying a MEDLINE search and discusses the pathogenesis and therapeutic options of these aneurysms leading to external compression over the bile duct. Consequently, the formation of PDA with obstructive jaundice is based on the specific anatomy of pancreaticoduodenal arcades. When there is a retroperitoneal mass around the head of the pancreas associated with unexpected jaundice, PDA should be considered, for which early aggressive therapy is required. The case report and literature review suggest that PDA associated with obstructive jaundice may be treated successfully by single transcatheter arterial embolization (TAE) without auxiliary biliary drainage, whether it ruptures or not.
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Affiliation(s)
- Tiansheng Yin
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhili Wan
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hongwei Chen
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xixian Mao
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yayang Yi
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dewei Li
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Dolenšek J, Rupnik MS, Stožer A. Structural similarities and differences between the human and the mouse pancreas. Islets 2015; 7:e1024405. [PMID: 26030186 PMCID: PMC4589993 DOI: 10.1080/19382014.2015.1024405] [Citation(s) in RCA: 225] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 02/20/2015] [Accepted: 02/23/2015] [Indexed: 02/08/2023] Open
Abstract
Mice remain the most studied animal model in pancreas research. Since the findings of this research are typically extrapolated to humans, it is important to understand both similarities and differences between the 2 species. Beside the apparent difference in size and macroscopic organization of the organ in the 2 species, there are a number of less evident and only recently described differences in organization of the acinar and ductal exocrine tissue, as well as in the distribution, composition, and architecture of the endocrine islets of Langerhans. Furthermore, the differences in arterial, venous, and lymphatic vessels, as well as innervation are potentially important. In this article, the structure of the human and the mouse pancreas, together with the similarities and differences between them are reviewed in detail in the light of conceivable repercussions for basic research and clinical application.
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Affiliation(s)
- Jurij Dolenšek
- Institute of Physiology; Faculty of Medicine; University of Maribor; Maribor, Slovenia
| | - Marjan Slak Rupnik
- Institute of Physiology; Faculty of Medicine; University of Maribor; Maribor, Slovenia
- Centre for Open Innovations and Research Core@UM; University of Maribor; Maribor, Slovenia
- Institute of Physiology; Center for Physiology and Pharmacology; Medical University of Vienna; Vienna, Austria
| | - Andraž Stožer
- Institute of Physiology; Faculty of Medicine; University of Maribor; Maribor, Slovenia
- Centre for Open Innovations and Research Core@UM; University of Maribor; Maribor, Slovenia
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Mosca S, Di Gregorio F, Regoli M, Bertelli E. The superior horizontal pancreatic artery of Popova: a review and an anatomoradiological study of an important morphological variant of the pancreatica magna artery. Surg Radiol Anat 2014; 36:1043-9. [PMID: 24599560 DOI: 10.1007/s00276-014-1276-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 02/17/2014] [Indexed: 12/14/2022]
Abstract
PURPOSE The superior horizontal pancreatic artery was described in 1910, and after a few years, it was forgot by most investigators. This research is aimed to revive the description of this artery, describing course, pattern of branching and frequency. METHODS More than 1,000 of angiographies including studies of the superior mesenteric artery, celiac trunk and its branches, were selected from the angiographic archives of the ex-institutes of Radiology of Siena, Rome (University of Sacro Cuore) and Perugia, and the arterial anatomy of the pancreas was studied. RESULTS A pancreatic branch of the splenic artery running along the superior border of the pancreatic body and tail was observed in 25.93% of cases. This branch matched the description of the superior horizontal pancreatic artery and, when existing, replaced the pancreatica magna artery. For this reason, we considered the superior horizontal pancreatic artery as a variant of the pancreatica magna artery. Variable in caliber and importance, in most cases the superior horizontal pancreatic artery gave off descending branches that anastomosed with the inferior pancreatic artery. CONCLUSIONS A superior horizontal pancreatic artery could be visualized more easily by selective angiography of the splenic artery. When coupled with the inferior pancreatic artery, the presence of the superior horizontal pancreatic artery outlined a longitudinally arranged pattern of blood supply of the distal pancreas that should be known. In particular circumstances, extended resections of the gland cutting both longitudinal arteries might jeopardize the surviving of the pancreas remnant.
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Affiliation(s)
- S Mosca
- Department of Diagnostic Imaging, University of Perugia, Perugia, Italy
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32
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Di Gregorio F, Regoli M, Botta G, Bertelli E. Right gastroepiploic artery arising from the dorsal pancreatic artery: a very rare anatomic variation underlying interesting embryologic implications. Surg Radiol Anat 2014; 37:109-14. [DOI: 10.1007/s00276-014-1273-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 02/13/2014] [Indexed: 11/30/2022]
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Tsutsumi M, Arakawa T, Terashima T, Aizawa Y, Kageyama I, Kumaki K, Miki A. Morphological analysis of the branches of the dorsal pancreatic artery and their clinical significance. Clin Anat 2013; 27:645-52. [DOI: 10.1002/ca.22331] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 06/12/2013] [Accepted: 09/08/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Masahiro Tsutsumi
- Department of Rehabilitation Sciences; Kobe Graduate School of Health Sciences, 7-10-2, Tomogaoka, Suma-ku; Kobe 654-0142 Japan
| | - Takamitsu Arakawa
- Department of Rehabilitation Sciences; Kobe Graduate School of Health Sciences, 7-10-2, Tomogaoka, Suma-ku; Kobe 654-0142 Japan
| | - Toshio Terashima
- Division of Developmental Neurobiology, Department of Physiology and Cell Biology; Kobe University Graduate School of Medicine; 7-5-2, Kusunoki-cho Chuo-ku Kobe 650-0017 Japan
| | - Yukio Aizawa
- Department of Anatomy; the Nippon Dental University School of Life Dentistry at Niigata; 1-8 Hamaura-cho Chuo-ku Niigata 951-8580 Japan
| | - Ikuo Kageyama
- Department of Anatomy; the Nippon Dental University School of Life Dentistry at Niigata; 1-8 Hamaura-cho Chuo-ku Niigata 951-8580 Japan
| | - Katsuji Kumaki
- Niigata Graduate School of Rehabilitation; 2-16, Kaminoyama Murakami 958-0053 Japan
| | - Akinori Miki
- Department of Rehabilitation Sciences; Kobe Graduate School of Health Sciences, 7-10-2, Tomogaoka, Suma-ku; Kobe 654-0142 Japan
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Perera MTPR, Muiesan P, Mirza DF. Feasibility of safe procurement of isolated intestinal and pancreatic grafts. Transpl Int 2013; 26:e97-8. [DOI: 10.1111/tri.12146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Paolo Muiesan
- The Liver Unit; Birmingham Children's Hospital; Birmingham UK
| | - Darius F. Mirza
- The Liver Unit; Queen Elizabeth Hospital Birmingham; Birmingham UK
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35
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Lee AJ, Gomes AS, Liu DM, Kee ST, Loh CT, McWilliams JP. The road less traveled: importance of the lesser branches of the celiac axis in liver embolotherapy. Radiographics 2012; 32:1121-32. [PMID: 22786998 DOI: 10.1148/rg.324115114] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Effective treatment of unresectable hepatic neoplasms depends on the appropriate identification of tumor arterial supply. Because hepatic tumors derive more than 90% of their blood supply from the hepatic arteries, awareness of common hepatic arterial anatomic variants (e.g., replaced or accessory left or right hepatic artery), as well as parasitized collateral vessels originating from the celiac axis (e.g., right inferior phrenic, omental, and cystic arteries) that can supply hepatic neoplasms-particularly those with a surface location-is important for safe and effective interventional therapy for these tumors. Moreover, recognition of certain nonhepatic branches arising from the hepatic arterial circulation is important for optimizing transarterial therapy and blocking the passage of treatment particles into sensitive structures, thereby preventing unwanted clinical sequelae such as gastrointestinal ulceration, skin ulceration or pain, and, rarely, ischemic cholecystitis.
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Affiliation(s)
- Aram J Lee
- Department of Interventional Radiology, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 1638, Los Angeles, CA 90095-7437, USA.
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Wu ZX, Yang XZ, Cai JQ, Liao LM, Yang L, Lin YN, Tan JM. Digital subtraction angiography and computed tomography angiography of predominant artery feeding pancreatic body and tail. Diabetes Technol Ther 2011; 13:537-41. [PMID: 21406019 DOI: 10.1089/dia.2010.0173] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Recently a considerable number of promising clinical trials have been designed to perform infusion of stem cells by pancreatic arterial intervention to improve the endocrine function of the pancreas for better diabetes control. It is necessary to investigate the pancreatic body and tail (PBT) arterial system for human islets located mostly in the PBT and identify the predominant artery or arteries. However, the arterial system in the PBT is complicated and variable. In this study we comprehensively investigated the anatomical characteristics of arteries feeding the PBT. RESEARCH DESIGN AND METHODS One hundred two patients with diabetes underwent 64-slice computed tomography angiography (CTA) and digital subtraction angiography (DSA). The target artery was catheterized, and DSA was performed to show the PBT. All images were documented for later analysis. RESULTS DSA demonstrated that the feeding arteries for the PBT included the dorsal pancreatic artery (DPA) alone (n = 51 [50%]), combined DPA and great pancreatic artery (GPA) (n = 22 [21.6%]), GPA alone (n = 16 [15.7%]), and transverse pancreatic artery (TPA) (n = 11 [10.8%]). DPA was observed to originate from the initial segment of the splenic artery (n = 34 [46.6%]), common hepatic artery (n = 17 [23.3%]), or superior mesenteric artery (n = 14 [19.2%]). The GPA was mostly from the middle (n = 36 [94.7%]), and only two were found to originate from the initial segment of the splenic artery. The TPA (n = 11) was from either the pancreatoduodenal artery (n = 5 [54.5%]) or the gastroduodenal artery (n = 4 [36.4%]). In most case, the predominant artery of the PBT (95.1%, 97 of 102) could be revealed by 64-slice CTA. CONCLUSIONS The origins and identities of the predominant artery in the PBT are variable. DSA is superior to CTA for preoperative imaging in arterial intervention therapy.
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Affiliation(s)
- Zhi-xian Wu
- Transplant Center, Fuzhou Medical College, Fuzhou General Hospital, Second Military Medical University, Fuzhou, China
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Lin Y, Yang X, Chen Z, Tan J, Zhong Q, Yang L, Wu Z. Demonstration of the dorsal pancreatic artery by CTA to facilitate superselective arterial infusion of stem cells into the pancreas. Eur J Radiol 2011; 81:461-5. [PMID: 21316172 DOI: 10.1016/j.ejrad.2010.12.077] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2010] [Revised: 12/16/2010] [Accepted: 12/28/2010] [Indexed: 11/17/2022]
Abstract
PURPOSE To investigate the diagnostic performance of 64-section CTA in the detection of dorsal pancreatic artery before interventional therapy for patients with diabetes. MATERIALS AND METHODS The study was approved by the institutional ethics committee; written informed consent was obtained. Forty-two consecutive patients with diabetes received an experimental treatment of autologous bone marrow-derived stem cell transplantation by means of infusion into the dorsal pancreatic artery. All cases underwent abdominal CTA before angiography of pancreatic arteries in order to locate the origin and course of dorsal pancreatic artery. Angiography of coeliac artery, splenic artery, common hepatic artery and superior mesenteric artery were performed both in CTA and DSA. Superselective catheterization of dorsal pancreatic artery was carried out for the infusion of stem cell. Sensitivity, specificity and accuracy for the detection of dorsal pancreatic artery with CTA were calculated using DSA images as the reference standard. RESULTS Thirty-five and thirty-six dorsal pancreatic arteries were detected by CTA and DSA respectively. Dorsal pancreatic artery was not visualized in either CTA or DSA in 5 patients. The sensitivity, specificity and accuracy for CTA were 94.4%, 83.3% and 92.9%. CONCLUSION 64-section CTA is accurate for the detection of dorsal pancreatic artery. It may be useful for the facilitation of superselective arterial infusion of stem cells to pancreas.
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Affiliation(s)
- Yuning Lin
- Department of Medical Imaging, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA, Fuzhou 350025, Fujian Province, China.
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Arterial anatomy of the pancreas. Part 3: segmented computed tomography-angiography mapping of perineural invasion. J Comput Assist Tomogr 2011; 34:961-5. [PMID: 21084917 DOI: 10.1097/rct.0b013e3181dd5bfc] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This is the third in a series of medical graphics articles featuring the arterial anatomy of the pancreas as depicted on segmented computed tomography-angiography. These segmented computed tomography-angiography displays serve as a road map of the routes of tumor spread by ductal adenocarcinoma of the pancreas because perineural tumor invasion parallels the pancreatic arteries.
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Arterial supply to the pancreas; variations and cross-sectional anatomy. ACTA ACUST UNITED AC 2010; 35:134-42. [PMID: 19777288 DOI: 10.1007/s00261-009-9581-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The pancreas has complex arterial supplies. Therefore, special attention should be paid in pancreatic arterial intervention for patients with acute pancreatitis and pancreatic carcinomas. Knowledge of pancreatic arterial anatomy and arterial territory is important not only to perform pancreatic arterial intervention, but to read the pancreatic angiography and cross-sectional image. We reviewed 226 selective abdominal angiography and CT scans during selective arteriography (CTA) of common hepatic artery, superior mesenteric artery, splenic artery, or peripancreatic arteries including posterior superior pancreaticoduodenal artery, anterior superior pancreaticoduodenal artery, inferior pancreaticoduodenal artery, and dorsal pancreatic artery. CTA images were evaluated to clarify the cross-sectional anatomy of the pancreatic arterial territory. Variations of the peripancreatic arteries were also investigated. In this exhibit, schemes and illustrative cases demonstrate pancreatic arterial territory and variations.
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Margreiter C, Mark W, Wiedemann D, Sucher R, Öllinger R, Bösmüller C, Freund M, Maier HT, Greiner A, Fritsch H, Pratschke J, Margreiter R, Aigner F. Pancreatic graft survival despite partial vascular graft thrombosis due to splenocephalic anastomoses. Am J Transplant 2010; 10:846-851. [PMID: 20420640 DOI: 10.1111/j.1600-6143.2010.03060.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Thrombotic complications following pancreas transplantation are still the most common cause of nonimmunologic graft loss. The aim of this study was to analyze pancreatic graft function after partial arterial graft thrombosis and the investigation of the pancreatic arterial anatomy with regard to intraparenchymal anastomoses. We retrospectively analyzed the data for 175 consecutive pancreas transplants performed between January 2002 and October 2007. Selective Y-graft angiography was performed in 10 and rubber-milk injection in 5 fresh pancreas specimens. Thrombosis of one leg of the Y-graft was diagnosed in 18 (10.3%) patients. Only one of these patients with thrombosis of the splenic artery required exogenous insulin. Sufficient graft perfusion was demonstrated in all of the remaining grafts. One graft was lost due to acute rejection. In all specimens angiography showed an excellent perfusion of the pancreaticoduodenal arcade, even after selective cannulation of the splenic artery. Arterial collaterals between the gastroduodenal, splenic artery and the superior mesenteric artery were demonstrated. Our results demonstrate that global perfusion of the pancreatic graft and sufficient graft function is sustained after the thrombotic occlusion of one branch of the Y-graft by a complex system of intraparenchymal anastomoses. These anatomical findings may have consequences for resection strategies in pancreas surgery.
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Affiliation(s)
- C Margreiter
- Department of Visceral, Transplant and Thoracic Surgery
| | - W Mark
- Department of Visceral, Transplant and Thoracic Surgery
| | | | - R Sucher
- Department of Visceral, Transplant and Thoracic Surgery
| | - R Öllinger
- Department of Visceral, Transplant and Thoracic Surgery
| | - C Bösmüller
- Department of Visceral, Transplant and Thoracic Surgery
| | - M Freund
- Department of Diagnostic Radiology
| | - H T Maier
- Department of Visceral, Transplant and Thoracic Surgery
| | | | - H Fritsch
- Department of Anatomy, Histology and Embryology, Division of Clinical and Functional Anatomy, Innsbruck Medical University, Innsbruck, Austria
| | - J Pratschke
- Department of Visceral, Transplant and Thoracic Surgery
| | - R Margreiter
- Department of Visceral, Transplant and Thoracic Surgery
| | - F Aigner
- Department of Visceral, Transplant and Thoracic Surgery
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Gawenda M, Libicher M. Commentary: Imaging to Estimate the Safety of Intentional Celiac Trunk Coverage in TEVAR: Multislice CTA Cannot Replace Angiography at Present. J Endovasc Ther 2009; 16:55-8; discussion 58-9. [DOI: 10.1583/08-2549c.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Seneviratne DR, Mollan SP, Elsherbiny S, Worstmann T. Giant cell arteritis complicated by acute pancreatitis: a case report. J Med Case Rep 2008; 2:346. [PMID: 19014625 PMCID: PMC2596799 DOI: 10.1186/1752-1947-2-346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2008] [Accepted: 11/17/2008] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION We describe a case of giant cell arteritis in a woman who was treated with high-dose systemic corticosteroids and subsequently developed acute pancreatitis. CASE PRESENTATION A 78-year-old Caucasian woman presented with four weeks of progressive headache and scalp tenderness. One day before ophthalmology assessment, she had experienced visual obscurations in both eyes. Her visual acuity was 6/9 in both eyes, with a right afferent pupillary defect and right swollen optic nerve. She was diagnosed as having temporal arteritis and was urgently treated with high-dose pulsed intravenous and oral corticosteroids. Her previous diet-controlled diabetes needed insulin and oral hyperglycaemic therapy to control erratic blood sugars. On day 8 of treatment with steroids, she became unwell with epigastric pain and vomiting. She was diagnosed with acute pancreatitis and was treated conservatively. CONCLUSION Acute pancreatitis, a potentially life-threatening condition, is a rare but important side effect of systemic corticosteroids.
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Libicher M, Reichert V, Aleksic M, Brunkwall J, Lackner KJ, Gawenda M. Balloon Occlusion of the Celiac Artery: A Test for Evaluation of Collateral Circulation Prior Endovascular Coverage. Eur J Vasc Endovasc Surg 2008; 36:303-5. [DOI: 10.1016/j.ejvs.2008.04.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2007] [Accepted: 04/13/2008] [Indexed: 10/22/2022]
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Horiguchi A, Ishihara S, Ito M, Nagata H, Asano Y, Yamamoto T, Kato R, Katada K, Miyakawa S. Multislice CT study of pancreatic head arterial dominance. ACTA ACUST UNITED AC 2008; 15:322-6. [DOI: 10.1007/s00534-007-1261-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2007] [Accepted: 08/13/2007] [Indexed: 12/29/2022]
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Evaluation of the vascular supply to regions of the pancreas on CT during arteriography. ACTA ACUST UNITED AC 2008; 33:563-70. [DOI: 10.1007/s00261-007-9342-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Cuesta AMDL, Alonso-Burgos A, Vivas I, Salem R, Bilbao JI. Vascular Anatomy and Its Implication in Radioembolization. LIVER RADIOEMBOLIZATION WITH 90Y MICROSPHERES 2008. [DOI: 10.1007/978-3-540-35423-9_4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Kalva SP, Athanasoulis CA, Greenfield AJ, Fan CM, Curvelo M, Waltman AC, Wicky S. Inferior pancreaticoduodenal artery aneurysms in association with celiac axis stenosis or occlusion. Eur J Vasc Endovasc Surg 2007; 33:670-5. [PMID: 17276102 DOI: 10.1016/j.ejvs.2006.12.021] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2006] [Accepted: 12/18/2006] [Indexed: 12/17/2022]
Abstract
PURPOSE To describe the pathophysiology, identification and management of inferior pancreaticoduodenal artery aneurysms in association with celiac axis stenosis or occlusion has been reported. REVIEW FINDINGS These aneurysms are thought to arise due to increased flow through the pancreaticoduodenal arcades. The arcades first enlarge, and then form focal aneurysms which may rupture. The aneurysms can be treated through endovascular techniques or by surgery, though the former is a preferred approach.
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Affiliation(s)
- S P Kalva
- Radiology, Massachusetts General Hospital, Boston, MA, USA.
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Jin G, Tuo H, Sugiyama M, Oki A, Abe N, Mori T, Masaki T, Atomi Y. Anatomic study of the superior right colic vein: its relevance to pancreatic and colonic surgery. Am J Surg 2006; 191:100-3. [PMID: 16399115 DOI: 10.1016/j.amjsurg.2005.10.009] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2005] [Revised: 08/30/2005] [Indexed: 12/16/2022]
Abstract
BACKGROUND This study was designed to describe the precise anatomic venous tributaries of the superior mesenteric vein with special emphasis on the superior right colic vein (SRCV), which is seldom mentioned in the literature. METHODS Nine adult cadavers were dissected to define the venous tributaries of the superior mesenteric vein. The SRCV, middle colic vein, and right colic vein (RCV) were defined as those that drained from the marginal vein of the right flexure of the colon, the transverse colon, and the ascending colon, respectively. RESULTS The SRCV was observed to drain from the right flexure of the colon to the confluence of the right gastroepiploic and superior pancreaticoduodenal veins and present the gastrocolic trunk of Henle (GTH) in 8 of 9 cases. The RCV terminated into the GTH in 4 cases. The SRCV, the RCV, and the middle colic vein formed a confluence and entered into the GTH in 1 case. CONCLUSIONS The SRCV exits and drains from the right colonic flexure to the GTH in 89% of cases.
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Affiliation(s)
- Gang Jin
- First Department of Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan
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Zhou H, Tran POT, Yang S, Zhang T, LeRoy E, Oseid E, Robertson RP. Regulation of alpha-cell function by the beta-cell during hypoglycemia in Wistar rats: the "switch-off" hypothesis. Diabetes 2004; 53:1482-7. [PMID: 15161752 DOI: 10.2337/diabetes.53.6.1482] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The glucagon response is the first line of defense against hypoglycemia and is lost in insulin-dependent diabetes. The beta-cell "switch-off" hypothesis proposes that a sudden cessation of insulin secretion from beta-cells into the portal circulation of the islet during hypoglycemia is a necessary signal for the glucagon response from downstream alpha-cells. Although indirect evidence exists to support this hypothesis, it has not been directly tested in vivo by provision and then discontinuation of regional reinsulinization of alpha-cells at the time of a hypoglycemic challenge. We studied streptozotocin (STZ)-induced diabetic Wistar rats that had no glucagon response to a hypoglycemic challenge. We reestablished insulin regulation of the alpha-cell by regionally infusing insulin (0.025 microU/min) directly into the superior pancreaticoduodenal artery (SPDa) of STZ-administered rats at an infusion rate that did not alter systemic venous glucose levels. SPDa insulin infusion was switched off simultaneously when blood glucose fell to <60 mg/dl after a jugular venous insulin injection. This maneuver restored the glucagon response to hypoglycemia (peak change within 5-10 min = 326 +/- 98 pg/ml, P < 0.05; and peak change within 15-20 min = 564 +/- 148 pg/ml, P < 0.01). No response was observed when the SPDa insulin infusion was not turned off (peak change within 5-10 min = 44 +/- 85 pg/ml, P = NS; and peak change within 15-20 min = 67 +/- 97 pg/ml, P = NS) or when saline instead of insulin was infused and then switched off (peak change within 5-10 min = -44 +/- 108 pg/ml, P = NS; and peak change within 15-20 min = -13 +/- 43 pg/ml, P = NS). No responses were observed during euglycemia (peak change within 5-10 min = 48 +/- 35 pg/ml, P = NS; and peak change within 15-20 min = 259 +/- 129 pg/ml, P = NS) or hyperglycemia (peak change within 5-10 min = 49 +/- 62 pg/ml, P = NS; and peak change within 15-20 min = 138 +/- 87 pg/ml, P = NS). Thus, the glucagon response to hypoglycemia that was absent in rats made diabetic by STZ was restored by regional infusion and then discontinuation of insulin. These data provide direct in vivo support for the beta-cell "switch-off" hypothesis and indicate that the alpha-cell is not intrinsically abnormal in insulin-dependent diabetes because of STZ-induced destruction of beta-cells.
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Affiliation(s)
- Huarong Zhou
- Pacific Northwest Research Institute, 720 Broadway, Seattle, WA 98122, USA
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