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

George H. Sakorafas, Michael G. Sarr, George Peros

Research output: Contribution to journalReview article

35 Scopus citations

Abstract

Because of the prevalence of CAS, the pancreatic surgeon needs to maintain a high index of suspicion whenever the preoperative imaging shows extensive pancreatic arterial collateralization, or when intraoperative findings show extensive pancreaticoduodenal collateral vessels, an enlarged GDA, or other unusual arterial anatomy. Because PD disrupts or resects these collateral pathways, potentially providing the only arterial supply to the celiac artery distribution, the ability to revascularize a branch of the celiac artery or to maintain certain collateral supply must be readily available in the operative armamentarium. The type of revascularization depends on the cause of CAS-either celiac decompression for external compression or vascular bypass/celiac branch reimplantation for ostial stenosis. Preoperative diagnosis offers the potential for preoperative revascularization through minimally invasive endovascular techniques. Although the need for aggressive revascularization is rare, when needed, it is imperative, and the surgeon needs to be prepared.

Original languageEnglish (US)
Pages (from-to)349-356
Number of pages8
JournalJournal of the American College of Surgeons
Volume206
Issue number2
DOIs
StatePublished - Feb 1 2008

    Fingerprint

ASJC Scopus subject areas

  • Surgery

Cite this