title: Managing arterial collaterals due to coeliac axis stenosis during pancreaticoduodenectomy.
abstract: BACKGROUND
  Coeliac artery stenosis is a condition affecting a minority of patients undergoing pancreaticoduodenectomy. In such cases, the development of collateral pathways through the blood supply of the pancreatic head provides challenges for surgical management.
  
  
  METHODS
  We report a case of coeliac artery stenosis in a patient undergoing pancreaticoduodenectomy. The main blood supply for the coeliac axis was through a single collateral channel, formed by the anterior pancreaticoduodenal arterial arcade. We describe the preservation of this arcade, resection of the redundant artery with primary anastomosis and a review of the literature.
  
  
  CONCLUSIONS
  Management of coeliac artery stenosis during pancreaticoduodenectomy depends on identifying the cause and dealing with it accordingly, intraoperatively.
authors.affiliation: Institute of Liver Studies, Kings College Hospital, London, UK.
authors.forename: Shady T
authors.initials: ST
authors.lastname: El-Ghazaly Harb
authors.forename: Adrian W
authors.initials: AW
authors.lastname: O'Sullivan
authors.forename: Gabriele
authors.initials: G
authors.lastname: Marangoni
authors.forename: Nigel D
authors.initials: ND
authors.lastname: Heaton
authors.forename: Mohamed
authors.initials: M
authors.lastname: Rela
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D002445:Celiac Artery / Q000473:pathology*; D003097:Collateral Circulation / Q000502:physiology; D003251:Constriction, Pathologic / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008954:Models, Biological; D010179:Pancreas / Q000098:blood supply / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*