Middle colic artery-gastroepiploic artery bypass for compromised collateral flow in distal pancreatectomy with celiac artery resection.
OBJECTIVE
Radical distal pancreatectomy with en-bloc resection of the common hepatic, celiac, and left gastric arteries for pancreatic body cancer that involves these arteries does not routinely require arterial reconstruction because the collateral pathways via the pancreatoduodenal arcades from the superior mesenteric artery are recruited immediately. However, accidental injury to the pancreatoduodenal artery compromises collateral blood flow and may lead to fatal complications. This article describes the middle colic artery-gastroepiploic artery bypass as an emergent salvage procedure for restoring collateral flow.


METHODS
The inferior pancreatoduodenal artery was accidentally injured in 2 of 9 patients who underwent the radical procedure between 1997 and 2001. Microvascular anastomosis between the left branch of the middle colic artery and the gastroepiploic artery in an end-to-side fashion was employed.


RESULTS
The pulsation of the gastroepiploic artery and the color of the stomach recovered immediately after completion of the middle colic artery-gastroepiploic artery bypass. No ischemia-related complication developed postoperatively. Postoperative angiography showed the middle colic artery-gastroepiploic artery bypass supplying arterial flow to the liver, stomach, duodenum, and pancreas.


CONCLUSIONS
The middle colic artery-gastroepiploic artery bypass is an excellent alternative restoring compromised collateral flow via the pancreatoduodenal arcades when microsurgical technique is available.
Department of Surgical Oncology, Hokkaido University Graduate School of Medicine, Kita-15 Nishi-7, Kita-ku, Sapporo 060-8638, Japan. kondows@med.hokudai.ac.jp
Satoshi
S
Kondo
Yoshiyasu
Y
Ambo
Hiroyuki
H
Katoh
Satoshi
S
Hirano
Eiichi
E
Tanaka
Shunichi
S
Okushiba
Toshiaki
T
Morikawa
Hiroharu
H
Igawa
Yuhei
Y
Yamamoto
Tsuneki
T
Sugihara
D002445:Celiac Artery / Q000601:surgery*; D003097:Collateral Circulation; D024405:Gastroepiploic Artery / Q000601:surgery; D006801:Humans; D010179:Pancreas / Q000098:blood supply*; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000601:surgery*; D014656:Vascular Surgical Procedures