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Feasibility and Safety of Spleno-Aortic Bypass in Patients with Atheromatous Celiac Trunk Stenosis in Pancreaticoduodenectomy

  • Tullio Piardi
  • Rami RhaiemEmail author
  • Arman Aghei
  • Francesco Fleres
  • Yohann Renard
  • Ambroise Duprey
  • Daniele Sommacale
  • Reza Kianmanesh
Letter to the Editor

In cases of celiac trunk (Ct) occlusion in patients requiring pancreaticoduodenectomy (PD), hepatic arterial flow must be preserved to avoid complications, such as hepatic ischemia. From January 2012 to August 2018, 183 PD were performed in the Digestive and Hepatobiliary Surgery Department-University of Reims-France. In 5 patients (2.7%), we observed, in the preoperative imaging study, a pre-occlusive atheromatous stenosis of the Ct. Among them, 3 patients deemed non-manageable by endovascular techniques. Herein, we report the results of a new strategy with a spleno-aortic bypass (SAB) associated to PD to overcome the Ct stenosis.

Hepatic arterial blood supply in patients with stenosis of the Ct is provided from the superior mesenteric artery (SMA) via collateral pathways. Trede et al.1described the existence of “additional” collateral pathways from the SMA to the hepatic and splenic arteries (HA and SA), which guaranteed a sufficient blood flow to the upper abdominal organs in...

Notes

Author’s Contribution

Tullio Piardi: conception of the work, drafting the manuscript, final approval of the version to be published and agreement to be accountable for all aspects of the work.

Rami Rhaiem: conception of the work, drafting the manuscript, final approval of the version to be published and agreement to be accountable for all aspects of the work.

Arman Aghei: acquisition of data, drafting the manuscript, final approval of the version to be published and agreement to be accountable for all aspects of the work.

Francesco Fleres: acquisition of data, drafting the manuscript, final approval of the version to be published and agreement to be accountable for all aspects of the work.

Yohann Renard: interpretation and analysis of data, drafting the manuscript, final approval of the version to be published and agreement to be accountable for all aspects of the work.

Ambroise Duprey: interpretation and analysis of data, revising the manuscript, final approval of the version to be published and agreement to be accountable for all aspects of the work.

Daniele Sommacale: design of the work, revising the manuscript, final approval of the version to be published and agreement to be accountable for all aspects of the work.

Reza Kianmanesh: design of the work, revising the manuscript, final approval of the version to be published and agreement to be accountable for all aspects of the work.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Trede M. Vascular problems and techniques associated with pancreatectomy and regional pancreatectomy. In: Trede M, Carter DC, editors. Surgery of the pancreas. 2nd ed. New York: Churchill Livingstone, 1997, p 505–16.Google Scholar
  2. 2.
    Gaujoux S, Sauvanet A, Vullierme M. P, et al. Ischemic complications after pancreaticoduodenectomy: incidence, prevention, and management. Ann. Surg 2009; 249: 111–117.  https://doi.org/10.1097/SLA.0b013e3181930249 CrossRefGoogle Scholar
  3. 3.
    Yang F, Di Y, Li J, et al. Accuracy of routine multidetector computed tomography to identify arterial variants in patients scheduled for pancreaticoduodenectomy. World J Gastroenterol 2015; 21: 969–976.  https://doi.org/10.3748/wjg.v21.i3.969 CrossRefGoogle Scholar
  4. 4.
    Nakayama Y, Sugimoto M, Kobayashi T et al. Impact of pancreaticoduodenal arcade dilation on postoperative outcomes after pancreaticoduodenectomy. HPB 2018; 20: 49–56.  https://doi.org/10.1016/j.hpb.2017.08.019 CrossRefGoogle Scholar
  5. 5.
    Murakami Y, Uemura K, Yokoyama Y, et al. Celiac axis occlusion with replaced common hepatic artery and pancreatoduodenectomy. J Gastrointest Surg 2004;8: 520–522.  https://doi.org/10.1016/j.gassur.2004.01.003 CrossRefGoogle Scholar
  6. 6.
    Okamoto H, Suminaga Y, Toyama N, et al. Autogenous vein graft from iliac artery to splenic artery for celiac occlusion in pancreaticoduodenectomy. J Hepatobiliary Pancreat Surg 2003; 10: 109–112.  https://doi.org/10.1007/s10534-002-0831-7 Google Scholar
  7. 7.
    Portolani N, Tiberio G, Coniglio A, et al. Emergency celiac revascularization for supramesocolic ischemia during pancreaticoduodenectomy: report of a case. Surg Today 2004; 34: 616–618.  https://doi.org/10.1007/s00595-004-2755-z CrossRefGoogle Scholar
  8. 8.
    Sakorafas G, Sarr M, Peros G, et al. Celiac artery stenosis: an underappreciated and unpleasant surprise in patients undergoing pancreaticoduodenectomy. J Am Coll Surg 2008;206: 349–356.  https://doi.org/10.1016/j.jamcollsurg.2007.09.002 CrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  1. 1.Department of General, Digestive and Hepatobiliary Surgery, Robert Debré University HospitalUniversity of Champagne-ArdenneReimsFrance
  2. 2.Department of Vascular Surgery, Robert Debré University HospitalUniversity of Champagne-ArdenneReimsFrance

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