Surgical glance at pancreatic arterial anatomy

Aim. Study of anatomical variations of the pancreatic neck blood supply, which may affect the results of pancreaticoduodenectomy.Material and methods. Anatomic characteristics of arterial blood supply of pancreas were studied in 42 autopsied cases, who died from diseases not associated with abdominal organs failure. Clinical part of our study included 62 patients. Arterial anatomy was examined during early arterial phase of computer tomography. Options of the origin of the dorsa pancreatic artery were noted. All patients had “soft” pancreas confirmed by morphological examination and computer tomography. Main group included 20 patients. Dissection of the pancreas during pancreatoduodenectomy in this group were performed 10–15 mm left of portal vein confluence. Control (retrospective) group included 42 patients performed standard procedure, when pancreas was dissected above the portal vein confluence.Results. It was found that the neck of pancreas was supplied from dorsal pancreatic artery, found in all specimens. In 76% of cases it was a branch of splenic artery, in other cases – a branch of superior mesenteric artery. CT scan revealed the dorsal pancreatic artery in 54 (87.1%) people, in 8 patients the artery could not be identified. The dorsal pancreatic artery was a branch of the splenic artery in 64.8% of cases. In other cases it was a branch of the superior mesenteric artery, common hepatic artery, gastroduodenal artery and middle colon artery. If the dorsal pancreatic artery was a branch of the superior mesenteric, common hepatic, gastroduodenal artery, it was transected during lymphadenectomy. This led to higher frequency of postoperative pancreatic fistula.Conclusion. Localization of dorsal pancreatic artery must be taken into account during the pancreatoduodenectomy. That allows to decrease probability of postoperative pancreatic fistula.

Rare Variation of the Origin of Dorsal Pancreatic Artery: A Case Report

Transcatheter arterial chemoembolization (TACE) has become an important method for the treatment of liver cancer. It is necessary to super-select the tumor feeding artery, avoid arteries of normal tissues and organs, and avoid complications caused by ectopic embolization. This case is a rare variation of the origin of dorsal pancreatic artery in the course of TACE.

Transcirculation microballoon-assisted coil embolization for dorsal pancreatic artery aneurysm due to celiac artery dissection: A case report

The dorsal pancreatic artery is a part of peripancreatic arcade connecting celiac artery to transpancreatic artery. A dorsal pancreatic artery aneurysm derived from dissection of celiac artery is a rare pathology, and it sometimes requires ingenious strategy in an endovascular surgery. Hereby, we report a case of a patient who underwent coil embolization for dorsal pancreatic artery aneurysm due to celiac artery dissection by applying transcirculation approach of a balloon catheter through the peripancreatic arcade, which was successfully achieved.

The main arterial vessels of pancreatic isthmus and their importance in surgery

Aim. To optimize the ways of cross-section of the pancreas in its isthmus, taking into account the topography of the main arteries of this area. Methods. 43 organocomplexes representing pancreas with duodenum were studied. Injection mass was injected into arterial vessels with subsequent fixation in 4% formalin solution and final preparation of complexes. The main arteries of the isthmus of the pancreas, their places of origin and topography were evaluated. Results. The main arteries of the isthmus of the pancreas are the peripancreatic artery and the additional artery of the isthmus of the pancreas. Peripancreatic artery was observed in 97.67% of cases; it departed from the dorsal pancreatic artery in 93% of cases, from the third branch of the splenic artery in 7% of cases. The diameter at the point of departure was 1.610.12 mm. In 95.3%, the artery passed along the lower edge of pancreatic isthmus. The peripancreatic artery was connected to the gastroduodenal artery or its branches. The diameter of peripancreatic artery at the junction was 1.550.1 mm. An additional artery of the isthmus of the pancreas was found in 93% of cases. In 76.74% it departed from the basin of the dorsal pancreatic artery, in 9.3% from another branch of the splenic artery, in 13.95% directly from the splenic artery itself. The diameter at the point of departure was 1.060.1 mm. It passed along the upper edge of pancreatic isthmus and connected to the pool of the gastroduodenal artery. The diameter at the junction was 0.980.1 mm. The diameter of peripancreatic artery was 1.950.05 mm in the trunk type versus 1.480.05 mm in the branched type of blood supply. The diameter of the additional artery of the isthmus of the pancreas had no pronounced changes depending on the type of blood supply to the pancreas. Conclusion. The topography of the main arteries of the isthmus of the pancreas is constant and does not depend on their diameter and place of origin. The most vascularized zones of the isthmus of the pancreas are its lower and upper edges.