Collaterals management during pancreatoduodenectomy in patients with celiac axis stenosis: A systematic review of the literature
| Autor: | Redan Hassan, Quirino Lai, Adriano Consolo, Eleonore Choppin de Janvry, Fabio Melandro, Pasquale Berloco, Zoe Larghi Laureiro, Francesco Giovanardi, M. Garofalo, Gabriela A. Arroyo Murillo |
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| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Endocrinology Diabetes and Metabolism Ischemia Celiac axis pancreatoduodenal arcades Hepatic abscess 030230 surgery Surgical planning Whipple Procedure endocrinology 03 medical and health sciences liver ischemia 0302 clinical medicine Medicine In patient diabetes and metabolism Hepatology business.industry Median arcuate ligament median arcuate ligament splanchnic aneurysm Gastroenterology medicine.disease Stenosis medicine.anatomical_structure 030220 oncology & carcinogenesis Vascular flow endocrinology diabetes and metabolism Radiology business |
| Zdroj: | Pancreatology. 18:592-600 |
| ISSN: | 1424-3903 |
| Popis: | Background/Objectives Celiac axis stenosis (CAS) represents an uncommon and typically innocuous condition. However, when a pancreatic resection is required, a high risk for upper abdominal organs ischemia is observed. In presence of collaterals, such a risk is minimized if their preservation is realized. The aim of the present study is to systematically review the literature with the intent to address the routine management of collateral arteries in the case of CAS patients requiring pancreatoduodenectomy. Methods A systematic search was done in accordance with the PRISMA guidelines, using “celiac axis stenosis” AND “pancreatoduodenectomy” as MeSH terms. Seventy-four articles were initially screened: eventually, 30 articles were identified (n = 87). Results The main cause of CAS was median arcuate ligament (MAL) (n = 31; 35.6%), followed by atherosclerosis (n = 20; 23.0%). CAS was occasionally discovered during the Whipple procedure in 15 (17.2%) cases. Typically, MAL was divided during surgery (n = 24/31; 77.4%). In the great majority of cases (n = 83; 95.4%), vascular abnormalities involved the pancreatoduodenal arteries (i.e., dilatation, arcade, channels, aneurysms). Collateral arteries were typically preserved, being divided or reconstructed in only 14 (16.1%) cases, respectively. Severe ischemic complications were reported in six (6.9%) patients, 20.0% of whom were reported in patients with preoperatively unknown CAS (p-value 0.06). Conclusions A correct pre-operative evaluation of anatomical conditions as well as a correct surgical planning represent the paramount targets in CAS patients with arterial collaterals. Vascular flow must be always safeguarded preserving/reconstructing the collaterals or resolving the CAS, with the final intent to avoid dreadful intra- and post-operative complications. |
| Databáze: | OpenAIRE |
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