title: Spleen-preserving distal pancreatectomy with resection of the splenic vessels. Should one rely on the short gastric arteries?
abstract: BACKGROUND
  Knowing the collaterals is essential for a spleen-preserving distal pancreatectomy with resection of the splenic vessels.
  
  
  OBJECTIVE
  To ascertain the sources of the blood supply to the spleen after a spleen-preserving distal pancreatectomy with resection of the splenic vessels.
  
  
  METHODS
  Perfusion of the cadaveric left gastric and right gastroepiploic arteries with methylene blue after occlusion of all the arteries except the short gastric arteries (n=10). Intraoperative color Doppler ultrasound was used for the evaluation of the hilar arterial blood flow at distal pancreatectomy (n=23) after 1) clamping of the splenic artery alone, 2) clamping of the splenic and left gastroepiploic arteries and 3) clamping of the splenic and short gastric arteries. CT angiography of the gastric and splenic vessels before and after a spleen-preserving distal pancreatectomy (n=10).
  
  
  RESULTS
  Perfusion of the cadaveric arteries revealed no effective direct or indirect (through the submucous gastric arterial network) communication between the left gastric and the branches of the short gastric arteries. In no case did intraoperative color Doppler ultrasound detect any hilar arterial blood flow after the clamping of the splenic and left gastroepiploic arteries. The clamping of the short gastric arteries did not change the flow parameters. In none of the cases did a post-spleen-preserving distal pancreatectomy with resection of the splenic vessels CT angiography delineate the short gastric vessels supplying the spleen. In all cases, the gastroepiploic arcade was the main arterial pathway feeding the spleen.
  
  
  CONCLUSIONS
  Experimental, intra- and postoperative instrumental investigations did not show the short gastric arteries to be engaged in the blood supply to the spleen after a spleen-preserving distal pancreatectomy with resection of the splenic vessels. In all cases, the left gastroepiploic artery was the main collateral vessel.
authors: Department of Hepatopancreatobiliary Surgery, Vishnevsky Institute of Surgery, Moscow, Russia. v.egorov61@gmail.com
authors: Vyacheslav Ivanovich
authors: VI
authors: Egorov
authors: Nina Ivanovna
authors: NI
authors: Yashina
authors: Tatyana Valentinovna
authors: TV
authors: Zhurenkova
authors: Maria Vladimirovna
authors: MV
authors: Petukhova
authors: Nataliya Sergeyevna
authors: NS
authors: Starostina
authors: Svetlana Alekseyevna
authors: SA
authors: Zarinskaya
authors: Kristina Anatolyevna
authors: KA
authors: Dmitriyeva
authors: Tatyana Valentinovna
authors: TV
authors: Shevchenko
authors: Roman Valeryevich
authors: RV
authors: Petrov
mesh_terms: D000328:Adult; D001158:Arteries / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D002102:Cadaver; D005260:Female; D024405:Gastroepiploic Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000502:physiology / Q000601:surgery; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D059351:Organ Sparing Treatments / Q000379:methods*; D010180:Pancreatectomy / Q000379:methods*; D013154:Spleen / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013157:Splenic Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D013162:Splenic Vein / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D013270:Stomach / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D018615:Ultrasonography, Doppler, Color