Celiac Artery Stenosis: An Underappreciated and Unpleasant Surprise in Patients Undergoing Pancreaticoduodenectomy

摘要

Celiac artery stenosis (CAS) is a relatively common finding.1"3 In the presence of CAS, arterial blood supply to the pancreas, stomach, spleen, and liver is usually sustained through a well-developed system of pancreatkoduodenal collateral pathways. Blood supply to these organs has its origin mainly in the superior mesenteric artery (SMA). During pancreaticoduodenectomy (PD), many or most of these collateral vessels are ligated and divided, thereby generating an ischemic threat to the liver, biliary tree, and even the stomach. Ischemia of these organs can complicate early and late results of PD reconstruction and hepatic function. Presence of CAS is an important finding during PD, which can require preoperative endovascular stenting or intraop-erative revascularization.