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Yamada A. Editorial for "A new imaging classification for safer radial access visceral intervention of the liver and optimal case selection: A preliminary report". Hepatol Res 2024; 54:415-416. [PMID: 38509640 DOI: 10.1111/hepr.14037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Affiliation(s)
- Akira Yamada
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan
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Jalili J, Javadrashid R, Alvandfar D, Falahatian M, Jafarizadeh A, Alihosseini S, Hashemizadeh SE. Obstructive jaundice as a rare complication of multiple pancreaticoduodenal artery aneurysms due to median arcuate ligament syndrome: a case report and review of the literature. J Med Case Rep 2023; 17:385. [PMID: 37689729 PMCID: PMC10493028 DOI: 10.1186/s13256-023-04114-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 08/03/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND Obstructive jaundice has various causes, and one of the rarest is pancreaticoduodenal artery aneurysm (PDAA), which is often associated with celiac axis stenosis caused by median arcuate ligament syndrome (MALS). CASE PRESENTATION The patient was a 77-year-old Azeri woman who presented with progressive jaundice, vague abdominal pain, and abdominal distension from 6 months ago. The intra- and extrahepatic bile ducts were dilated, the liver's margin was slightly irregular, and the echogenicity of the liver was mildly heterogeneous in the initial ultrasound exam. A huge cystic mass with peripheral calcification and compressive effect on the common bile duct (CBD) was also seen near the pancreatic head, which was connected to the superior mesenteric artery (SMA) and had internal turbulent blood flow on color Doppler ultrasound. According to the computed tomography angiography (CTA) findings, the huge mass of the pancreatic head was diagnosed as a true aneurysm of the pancreaticoduodenal artery caused by MALS. Two similar smaller aneurysms were also present at the huge aneurysm's superior margin. Due to impending rupture signs in the huge aneurysm, the severe compression effect of this aneurysm on CBD, and the patient's family will surgery was chosen for the patient to resect the aneurysms, but unfortunately, the patient died on the first day after the operation due to hemorrhagic shock. CONCLUSION In unexpected obstructive jaundice due to a mass with vascular origin in the head of the pancreas, PDAA should be considered, and celiac trunk should be evaluated because the main reason for PDAA is celiac trunk stenosis or occlusion by atherosclerosis or MALS. The treatment method chosen (including transarterial embolization, open surgery, or combined method) depends on the patient's clinical status and radiological findings, but transarterial embolization would be safer and should be used as a first-line method.
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Affiliation(s)
- Javad Jalili
- Medical Radiation Sciences Research Group, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Radiology, Emam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Javadrashid
- Medical Radiation Sciences Research Group, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Radiology, Emam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Dara Alvandfar
- Department of General Surgery, Emam Reza Hospital, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masih Falahatian
- Medical Radiation Sciences Research Group, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Ali Jafarizadeh
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Samin Alihosseini
- Medical Radiation Sciences Research Group, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyedeh Elnaz Hashemizadeh
- Department of Surgical and Clinical Pathology, Emam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
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Yoshida E, Kimura Y, Kyuno T, Kawagishi R, Sato K, Kono T, Chiba T, Kimura T, Yonezawa H, Funato O, Kobayashi M, Murakami K, Takagane A, Takemasa I. Treatment strategy for pancreatic head cancer with celiac axis stenosis in pancreaticoduodenectomy: A case report and review of literature. World J Gastroenterol 2022; 28:868-877. [PMID: 35317096 PMCID: PMC8900579 DOI: 10.3748/wjg.v28.i8.868] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/07/2021] [Accepted: 01/22/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND During pancreaticoduodenectomy in patients with celiac axis (CA) stenosis due to compression by the median arcuate ligament (MAL), the MAL has to be divided to maintain hepatic blood flow in many cases. However, MAL division often fails, and success can only be determined intraoperatively. To overcome this problem, we performed endovascular CA stenting preoperatively, and thereafter safely performed pancreaticoduodenectomy. We present this case as a new preoperative treatment strategy that was successful.
CASE SUMMARY A 77-year-old man with a diagnosis of pancreatic head cancer presented to our department for surgery. Preoperative assessment revealed CA stenosis caused by MAL. We performed endovascular stenting in the CA preoperatively because we knew that going into the operation without a strategy could lead to ischemic complications. Double-antiplatelet therapy (DAPT) – which is needed when a stent is inserted – was then administered in parallel with neoadjuvant chemotherapy (NAC). This allowed us to administer DAPT for a sufficient period before the main pancreaticoduodenectomy procedure while obtaining therapeutic effects from NAC. Subtotal stomach-preserving pancreaticoduodenectomy was then performed. The operation did not require any unusual techniques and was performed safely. Postoperatively, the patient progressed well, without any ischemic complications. Histopathologically, curative resection was confirmed, and the patient had no recurrence or complications due to ischemia up to six months postoperatively.
CONCLUSION Preoperative endovascular stenting, with NAC and DAPT, is effective and safe prior to pancreaticoduodenectomy in potentially resectable pancreatic cancer.
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Affiliation(s)
- Eiji Yoshida
- Department of Surgery, Hakodate Goryoukaku Hospital, Hakodate City 040-8611, Japan
| | - Yasutoshi Kimura
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo City 060-8543, Hokkaido, Japan
| | - Takuro Kyuno
- Department of Surgery, Hakodate Goryoukaku Hospital, Hakodate City 040-8611, Japan
| | - Ryoko Kawagishi
- Department of Surgery, Hakodate Goryoukaku Hospital, Hakodate City 040-8611, Japan
| | - Kei Sato
- Department of Surgery, Hakodate Goryoukaku Hospital, Hakodate City 040-8611, Japan
| | - Tsuyoshi Kono
- Department of Surgery, Hakodate Goryoukaku Hospital, Hakodate City 040-8611, Japan
| | - Takehiro Chiba
- Department of Surgery, Hakodate Goryoukaku Hospital, Hakodate City 040-8611, Japan
| | - Toshimoto Kimura
- Department of Surgery, Hakodate Goryoukaku Hospital, Hakodate City 040-8611, Japan
| | - Hitoshi Yonezawa
- Department of Surgery, Hakodate Goryoukaku Hospital, Hakodate City 040-8611, Japan
| | - Osamu Funato
- Department of Surgery, Hakodate Goryoukaku Hospital, Hakodate City 040-8611, Japan
| | - Makoto Kobayashi
- Department of Surgery, Hakodate Goryoukaku Hospital, Hakodate City 040-8611, Japan
| | - Kenji Murakami
- Department of Diagnostic Radiology, Hakodate Goryoukaku Hospital, Hakodate City 040-8611, Japan
| | - Akinori Takagane
- Department of Surgery, Hakodate Goryoukaku Hospital, Hakodate City 040-8611, Japan
| | - Ichiro Takemasa
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo City 060-8543, Hokkaido, Japan
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Ito K, Takemura N, Inagaki F, Mihara F, Shida Y, Tajima T, Kokudo N. Diagnosis of celiac artery stenosis using multidetector computed tomography and evaluation of the collateral arteries within the mesopancreas of patients undergoing pancreaticoduodenectomy. Clin Anat 2021; 34:1035-1042. [PMID: 33373084 DOI: 10.1002/ca.23716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 12/04/2020] [Accepted: 12/20/2020] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Celiac artery (CA) stenosis (CAS), caused by various factors, is often asymptomatic because collateral blood flow from the superior mesenteric artery supplies the CA outflow region. The purpose of this study was to investigate the usefulness of multidetector computed tomography (MDCT) for diagnosing CAS and associated collateral artery formation, and elucidating the effect of CAS on the numbers and diameters of the arteries within the mesopancreas. MATERIALS AND METHODS We investigated 106 patients who underwent contrast-enhanced MDCT, before pancreaticoduodenectomy, between January 2015 and September 2019. MDCT was used to determine the percentage stenosis of the CAs; patients were classified into CAS (-) (0-29% stenosis) and CAS (+) (30-100% stenosis) groups. The dissection lines of the mesopancreas were classed as Level I or II, and the numbers and diameters of the arteries along each dissection line were counted and measured. RESULTS There were 27 CAS (+) patients and 79 CAS (-) patients. In the CAS (+) group there were more arteries and they had larger diameters than those in the CAS (-) group, at both Levels I and II. There were significantly more arteries when the CA stenosis was ≥30% and they had larger diameters when the stenosis was ≥50%. CONCLUSIONS MDCT is useful for diagnosing CAS, and CAS is associated with larger numbers and diameters of the arteries within the mesopancreas.
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Affiliation(s)
- Kyoji Ito
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Nobuyuki Takemura
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Fuyuki Inagaki
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Fuminori Mihara
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yoshitaka Shida
- Department of Radiology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Tsuyoshi Tajima
- Department of Radiology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Norihiro Kokudo
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
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Two-way Revascularization to Manage Celiac Artery Stenosis during Pancreaticoduodenectomy: A Case Report. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3423. [PMID: 33680671 PMCID: PMC7929557 DOI: 10.1097/gox.0000000000003423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/17/2020] [Indexed: 11/26/2022]
Abstract
Celiac artery (CA) occlusion, or stenosis, is not uncommon, and most cases are asymptomatic. If the CA is occluded, collateral circulation from the superior mesenteric artery (SMA) is maintained through the pancreaticoduodenal arcade. However, the pancreaticoduodenal arcade is removed if pancreaticoduodenectomy (PD) is performed, which results in ischemia of the liver, stomach, and residual pancreas. Thus, these patients require CA revascularization, which can include antegrade endovascular reconstruction and retrograde reconstruction using vascular anastomosis from the SMA system to the CA system. Both methods carry risks of restenosis or anastomotic thrombosis. We report a technique that involves a combination of both revascularization methods in an 89-year-old man who underwent PD for lower bile duct cancer. Preoperative endovascular stent placement in the CA preserved antegrade blood flow to the liver, and intraoperative vascular anastomosis of the jejunal artery and right gastroepiploic artery achieved retrograde blood flow. Although we confirmed both stent and anastomosis patency and blood circulation in our case, obstruction of 1 of these revascularization pathways would not likely lead to ischemia of the liver. Thus, our 2-way revascularization technique for managing celiac artery stenosis during PD may reduce the risk of organ ischemia.
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Alam W, Kamareddine MH, Geahchan A, Ghosn Y, Feghaly M, Chamseddine A, Bou Khalil R, Farhat S. Celiacomesenteric trunk associated with superior mesenteric artery aneurysm: A case report and review of literature. SAGE Open Med Case Rep 2020; 8:2050313X20938243. [PMID: 32843965 PMCID: PMC7418225 DOI: 10.1177/2050313x20938243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 06/03/2020] [Indexed: 12/27/2022] Open
Abstract
In rare cases, the celiac artery and the superior mesenteric artery arise from a common origin known as a common celiacomesenteric trunk. Celiac trunk stenosis or occlusion has been reported to accompany this anatomical aberrancy. Even rarer, are aneurysms associated with this common celiacomesenteric trunk. In general, visceral artery aneurysms are uncommon. We hereby present a 39-year-old female patient with a 1-month history of mild diffuse abdominal pain, with an incidental finding of superior mesenteric artery aneurysm on abdominal ultrasound. Subsequent contrast-enhanced computed tomography revealed severe narrowing of the celiac trunk and saccular aneurysmal dilatation of the superior mesenteric artery. Coil embolization of the aneurysm was performed, while maintaining persistent flow in the superior mesenteric artery and celiacomesenteric trunk. Visceral artery aneurysms are increasingly being identified incidentally with improvement in imaging techniques. The question lies whether to treat these aneurysms or observe. No universal guidelines exist regarding that matter, but the decision to intervene is made based on aneurysm location, size, and patient characteristics.
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Affiliation(s)
- Walid Alam
- Department of Internal Medicine, Saint George Hospital University Medical Center, Beirut, Lebanon
| | | | - Amine Geahchan
- Department of Radiology, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Youssef Ghosn
- Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Michel Feghaly
- Department of Vascular Surgery, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Abbas Chamseddine
- Department of Interventional Radiology, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Rola Bou Khalil
- Department of Endocrinology, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Said Farhat
- Department of Gastroenterology, Saint George Hospital University Medical Center, Beirut, Lebanon
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Miyazaki K, Morine Y, Saito Y, Yamada S, Tokuda K, Ikemoto T, Imura S, Shimada M. Pancreatoduodenectomy co-morbid with celiac axis compression syndrome: a report of three cases. Surg Case Rep 2020; 6:113. [PMID: 32449014 PMCID: PMC7246236 DOI: 10.1186/s40792-020-00878-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/17/2020] [Indexed: 02/06/2023] Open
Abstract
Background Celiac axis compression syndrome (CACS) is a relatively rare disease. Because of the nature of the blood flow in the celiac region when a pancreatoduodenectomy (PD) is performed for CACS, the celiac region can become ischemic. The aim of this study is to report on the importance of pre-operative diagnosis of CACS in terms of the outcomes for patients post-operatively. In this study, three 3 cases of PD co-morbid with CACS are reported: one intra-operative diagnosis case and two pre-operative diagnosis cases. Case presentation The one case, not diagnosed with CACS prior to the operation, had a hard post-operative course because of complication caused by ischemia of the celiac region compared with the two cases diagnosed prior to the operation, who had a good post-operative course because of pre-operative or intra-operative intervention. Conclusions Post-operative complications due to CACS are preventable by pre-operative diagnosis and appropriate interventions.
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Affiliation(s)
- Katsuki Miyazaki
- The Department of Digestive and Transplant Surgery, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 770-8503, Japan
| | - Yuji Morine
- The Department of Digestive and Transplant Surgery, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 770-8503, Japan
| | - Yu Saito
- The Department of Digestive and Transplant Surgery, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 770-8503, Japan
| | - Shinichiro Yamada
- The Department of Digestive and Transplant Surgery, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 770-8503, Japan
| | - Kazunori Tokuda
- The Department of Digestive and Transplant Surgery, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 770-8503, Japan
| | - Tetsuya Ikemoto
- The Department of Digestive and Transplant Surgery, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 770-8503, Japan
| | - Satoru Imura
- The Department of Digestive and Transplant Surgery, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 770-8503, Japan
| | - Mitsuo Shimada
- The Department of Digestive and Transplant Surgery, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 770-8503, Japan.
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Oikawa R, Ito K, Takemura N, Mihara F, Kokudo N. Arterial communication around the pancreatic tail enabled division of the gastroduodenal artery during pancreaticoduodenectomy in patient with complete celiac artery occlusion: a case report. Surg Case Rep 2020; 6:29. [PMID: 31993802 PMCID: PMC6987288 DOI: 10.1186/s40792-020-0787-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 01/06/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Stenosis or obstruction of the celiac artery (CA) is known as celiac artery stenosis (CAS) and is usually accompanied by the formation of arterial anastomosis between the superior mesenteric artery (SMA) system and the CA system. Arterial bypass is mainly achieved through the gastroduodenal artery (GDA); therefore, the division of the GDA during pancreaticoduodenectomy (PD) could pose a problem in patients with CAS. CASE PRESENTATION We reported a case of PD presenting complete occlusion of the CA, in which perfusion to organs in the CA system was maintained via peri-pancreatic arterial communication. There were complicated arterial anastomoses around the pancreas, which were clearly visualized on a three-dimensional reconstruction of the arterial system using multi-detector computed tomography. Among these complicated anastomoses, one well-developed anastomosis between the SMA and the splenic artery through the dorsal pancreatic artery (DPA) was identified. The DPA was considered to work as a potential collateral pathway from the SMA to organs in the CA system after division of the GDA. During surgery, Doppler ultrasonography detected hepatopetal arterial flow even after the GDA clamping; therefore, we performed typical PD with division of the GDA. The postoperative course of the patient was uneventful, and there was no sign of ischemic complications in the CA system organs including the liver, stomach or spleen. CONCLUSIONS Three-dimensional reconstruction of the arterial system using multi-detector computed tomography and the intraoperative GDA clamping test were useful to determine whether it was possible to divide the GDA in PD, in the case of CAS.
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Affiliation(s)
- Ryo Oikawa
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655 Japan
| | - Kyoji Ito
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655 Japan
| | - Nobuyuki Takemura
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655 Japan
| | - Fuminori Mihara
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655 Japan
| | - Norihiro Kokudo
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655 Japan
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