Abstract
ABSTRACT Background: Pancreaticoduodenectomy is the usual surgical option for curative treatment of periampullary cancer and carries a significant mortality. Arterial anomalies of the celiac axis are not uncommon and might lead to iatrogenic lesions or requiring arterial resection/reconstruction in a pancreatoduodenectomy. Aim: Determine the prevalence of arterial variations having implications in pancreatoduodenectomy. Methods: Celiac trunk and hepatic arterial system anatomy was retrospectively evaluated in 200 abdominal enhanced computed tomography studies. Results: Normal anatomy of hepatic arterial system was found in 87% of cases. An anomalous right hepatic artery was identified in 13% of cases. In 12 cases there was a substitute right hepatic artery arising from superior mesenteric artery and in two cases an accessory right hepatic artery with similar origin. A hepatomesenteric trunk was identified in seven cases and in five there was a right hepatic artery directly from the celiac trunk. All cases of anomalous right hepatic artery had a route was behind the pancreatic head and then, posteriorly and laterally, to the main portal vein before reaching the liver. Conclusions: Hepatic artery variations, such as anomalous right hepatic artery crossing posterior to the portal vein, are frequently seen (13%). These patients, when undergoing pancreatoduodenectomy, may require a change in the surgical approach to achieve an adequate resection. Preoperative imaging can clearly identify such variations and help to achieve a safer pancreatic head dissection with proper surgical planning.
Highlights
Surgical resection remains the only potentially curative treatment for cancer of the head of the pancreas, and pancreatoduodenectomy (PD) is the standard surgical option[8,10]
Dynamic images were obtained after endovenous injection of iopromide through an 18-gauge plastic catheter placed in an antecubital vein
A normal right hepatic artery (RHA) originating from the main trunk of the proper hepatic artery (Figure 1A) was found in 174 cases (87%)
Summary
Surgical resection remains the only potentially curative treatment for cancer of the head of the pancreas, and pancreatoduodenectomy (PD) is the standard surgical option[8,10]. Major vessels involvement around the pancreas can make the surgery even more challenging[4,6,23] especially if arterial resection and reconstruction are necessary[1,13,14,16]. Arterial anomalies of the celiac axis, mainly of hepatic arteries, are not uncommon. These variations can result in arterial involvement of the anomalous artery by the tumor and increase the risk of vascular injury. Awareness of patient vascular anatomy is important to avoid iatrogenic injury while performing a safe pancreatic head resection. The purpose of this study was to determine the prevalence of arterial variations that
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