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Multislice CT study of pancreatic head arterial dominance

  • Original Articles
  • Published:
Journal of Hepato-Biliary-Pancreatic Surgery

Abstract

Background/Purpose

When a pancreatoduodenectomy is to be conducted, preoperative understanding of the vascular anatomy of the pancreatic head is important in order to reduce intraoperative bleeding. Using multislice computed tomography (MS-CT), we investigated the depiction rate and branching of the inferior pancreaticoduodenal artery (IPDA) and dorsal pancreatic artery (DPA), afferent arteries to the pancreatic head.

Methods

In 109 patients (68 with pancreatic cancer, 21 with biliary tract cancer, 15 with intraductal papillary mucinous tumor of the pancreas, and 5 others), images were taken, using 64-row MS-CT, in the early and late arterial phases.

Results

The depiction rates were 98.2% for the IPDA and 96.3% for the DPA. Branching of the IPDA was categorized into three types: a type in which the IPDA formed a common vessel with the first jejunal branch (72.0%), a type in which the IPDA branched directly from the superior mesenteric artery (18.7%), and a type in which the anterior inferior pancreaticoduodenal artery (AIPDA) and posterior inferior pancreaticoduodenal artery (PIPDA) branched separately (9.3%). DPA branching was categorized into five types, in which the DPA branched from the splenic artery (40.0%), from the common hepatic artery (25.7%), from the superior mesenteric artery (20.0%), and from the celiac artery (8.6%), and a type in which the DPA branching did not follow any of the above patterns (5.7%).

Conclusions

MS-CT images of vascular architecture enable evaluation from any angle, which is not possible with conventional angiography, making MS-CT a useful diagnostic imaging technique for understanding the vascular anatomy of the pancreatic head prior to conducting pancreatoduodenectomy for diseases of the pancreatic head region.

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References

  1. Butturini G, Marcucci S, Molinari E, Mascetta G, Landoni L, Crippa S, et al. Complications after pancreaticoduodenectomy: the problem of current definitions. J Hepatobiliary Pancreat Surg 2006;13:207–211.

    Article  PubMed  Google Scholar 

  2. Abe H, Tsukada K, Takada T, Nagakawa T. The selection of pancreatic reconstruction techniques gives rise to higher incidences of morbidity: results of the 30th Japan Pancreatic Surgery Questionnaire Survey on pancreatoduodenectomy in Japan. J Hepatobiliary Pancreat Surg 2005;12:109–115.

    Article  PubMed  Google Scholar 

  3. Nagakawa T, Sanada H, Inagaki M, Sugawa J, Ueno K, Konishi I, et al. Long-term survivors after resection of carcinoma of the head of the pancreas: significance of histologically curative resection. J Hepatobiliary Pancreat Surg 2004;11:402–408.

    Article  PubMed  Google Scholar 

  4. Horiguchi A, Ishihara S, Ito M, Nagata H, Shimizu T, Furusawa K, et al. Pancreatoduodenectomy in which dissection of the efferent arteries of the head of the pancreas is performed first. J Hepatobiliary Pancreat Surg 2007;14:575–578.

    Article  PubMed  Google Scholar 

  5. Ohigashi H, Ishikawa O, Eguchi H, Yamada T, Sasaki Y, Noura S, et al. Early ligation of the inferior pancreaticoduodenal artery to reduce blood loss during pancreaticoduodenectomy. Hepatogastroenterology 2004;51:4–5.

    PubMed  Google Scholar 

  6. Bertelli E, Di Gregorio F, Bertelli L, Orazioli D, Bastianini A. The arterial blood supply of the pancreas: a review. IV. The anterior inferior and posterior pancreaticoduodenal aa., and minor sources of blood supply for the head of the pancreas. An anatomical review and radiologic study. Surg Radiol Anat 1997;19:203–212.

    PubMed  CAS  Google Scholar 

  7. Bertelli E, Di Gregorio F, Mosca S, Bastianini A. The arterial blood supply of the pancreas: a review. V. The dorsal pancreatic artery. An anatomic review and a radiologic study. Surg Radiol Anat 1998;20:445–452.

    Article  PubMed  CAS  Google Scholar 

  8. Toni R, Favero L, Mosca S, Ricci S, Vezzadini P. Quantitative clinical anatomy of the pancreatic arteries studied by selective celiac angiography. Surg Radiol Anat 1988;10:53–60.

    Article  PubMed  CAS  Google Scholar 

  9. Yamaguchi H, Wakiguchi S, Murakami G, Hata F, Hirata K, Shimada K, et al. Blood supply to the duodenal papilla and the communicating artery between the anterior and posterior pancreaticoduodenal arterial arcades. J Hepatobiliary Pancreat Surg 2001;8:238–244.

    Article  PubMed  CAS  Google Scholar 

  10. Sim JS, Choi BI, Han JK, Chung MJ, Chung JW, Park J, et al. Helical CT anatomy of pancreatic arteries. Abdom Imaging 1996;21:517–521.

    Article  PubMed  CAS  Google Scholar 

  11. Chong M, Patrick C, Schmiedl U. Pancreatic arterial anatomy: depiction with dual phase helical CT. Radiology 1998;208:537–541.

    PubMed  CAS  Google Scholar 

  12. Furukawa H, Iwata R, Moriyama N, Kosuge T. Blood supply to the pancreatic head, bile duct, and duodenum. Arch Surg 1999;134:1086–1090.

    Article  PubMed  CAS  Google Scholar 

  13. Chung HK, Patric C. Pancreaticoduodenal arcades and dorsal pancreatic artery: comparison of CT angiography with three-dimensional volume rendering, maximum intensity projection, and shaded-surface display. AJR Am J Roentgenol 1999;172:925–931.

    Google Scholar 

  14. Shioyama Y, Kimura M, Horihata K, Masuda M, Hagihira T, Okumura T, et al. Peripancreatic arteries in thin-section multislice helical CT. Abdom Imaging 2001;26:234–242.

    Article  PubMed  CAS  Google Scholar 

  15. Kimura M, Shioyama Y, Okumura T, Yamada K, Kawashima M, Minamiguchi H, et al. Very-high-flow injection rate for upper abdominal CT angiography. J Gastroenterol 2002;37:106–111.

    Article  PubMed  Google Scholar 

  16. Ishigaki S, Itoh S, Satake H, Ota T, Ishigaki T. CT depiction of small arteries in the pancreatic head: assessment using coronal reformatted images with 16-channel multislice CT. Abdom Imaging 2006;8:1–9.

    Google Scholar 

  17. Murakami G, Hirata K, Takamuro T, Mukaiya M, Hata F, Kitagawa S. Vascular anatomy of the pancreaticoduodenal region: a review. J Hepatobiliary Pancreat Surg 1999;6:55–68.

    Article  PubMed  CAS  Google Scholar 

  18. Matsumura H. The significance of the morphology of the dorsal pancreatic artery in determining the presence of the accessory right hepatic artery passing behind the portal vein. Acta Anat Nippon 1988;73:517–527.

    Google Scholar 

  19. Kimura W, Hirai I, Yamaguchi H, Wakiguchi S, Murakami G, Kimura Y. Surgical anatomy of arteries running transversely in the pancreas, with special reference to the superior transverse pancreatic arteries. Hepatogastroenterology 2004;51:973–979.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Second Department of Gastroenterological Surgery, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Japan

    Akihiko Horiguchi, Shin Ishihara, Masahiro Ito, Hideo Nagata, Yukio Asano, Toshiyuki Yamamoto & Shuichi Miyakawa

  2. Department of Radiology, Fujita Health University School of Medicine, Toyoake, Japan

    Ryoichi Kato & Kazuhiro Katada

Authors
  1. Akihiko Horiguchi
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  2. Shin Ishihara
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  3. Masahiro Ito
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  4. Hideo Nagata
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  5. Yukio Asano
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  6. Toshiyuki Yamamoto
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  7. Ryoichi Kato
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  8. Kazuhiro Katada
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  9. Shuichi Miyakawa
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Horiguchi, A., Ishihara, S., Ito, M. et al. Multislice CT study of pancreatic head arterial dominance. J Hepatobiliary Pancreat Surg 15, 322–326 (2008). https://doi.org/10.1007/s00534-007-1261-2

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  • DOI: https://doi.org/10.1007/s00534-007-1261-2

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