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Langenbeck's Archives of Surgery

, Volume 403, Issue 3, pp 341–348 | Cite as

Incidence and management of arterial injuries during pancreatectomy

  • Dyre Kleive
  • Mushegh A. Sahakyan
  • Ammar Khan
  • Bjarte Fosby
  • Pål-Dag Line
  • Knut Jørgen Labori
Original Article

Abstract

Purpose

The incidence of intraoperative arterial injury during pancreatectomy is not well described. This study aims to evaluate the incidence, management, and outcome of arterial injuries during pancreatectomy.

Methods

This is a retrospective study of 1535 consecutive patients undergoing pancreatectomy between 2006 and 2016 at Oslo University Hospital. The type of arterial injury and potential contributing factors were analyzed. Short-term outcomes were compared between patients with arterial injury and patients undergoing a planned arterial resection due to tumor involvement.

Results

Arterial injury was diagnosed in 14 patients (incidence 0.91%), while planned arterial resection was performed in 22 patients. The injuries were located in the superior mesenteric artery (n = 5), right hepatic artery (n = 5), common hepatic artery (n = 2), left hepatic artery (n = 1), and celiac trunk (n = 2). The artery was reconstructed in all except one patient. In 11 patients with injury, peripancreatic inflammation, aberrant arterial anatomy, close relationship between tumor and injured artery, or a combination of the three were found. Median estimated blood loss was 1100 ml in both groups. Rate of severe complications (≥ Clavien grade IIIa), comprehensive complication index, and 90-day mortality for patients with intraoperative arterial injury vs planned arterial resection were 43 vs 45% (p = 0.879), median 35.9 vs 21.8 (p = 0.287), and 14.3 vs 4.5% (p = 0.551), respectively.

Conclusion

Arterial injury during pancreatectomy is an infrequent and manageable complication. Early recognition and primary repair in order to restore arterial liver perfusion may improve outcome. However, the morbidity is high and comparable to patients undergoing a planned arterial resection.

Keywords

Arterial resection during pancreatectomy Arterial injury 

Notes

Authors’ contributions

Study conception and design: KJL; acquisition of data: all authors; analysis and interpretation of data: all authors; drafting the manuscript: DK, MS; critical revision of the manuscript: all authors.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Institute of Clinical MedicineUniversity of OsloOsloNorway
  2. 2.Department of Hepato-Pancreato-Biliary SurgeryRikshospitalet, Oslo University HospitalOsloNorway
  3. 3.Department of Surgery N1Yerevan State Medical University after M. HeratsiYerevanArmenia
  4. 4.The Intervention CentreOslo University HospitalOsloNorway
  5. 5.Department of Transplantation MedicineRikshospitalet, Oslo University HospitalOsloNorway

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