title: Celiac artery occlusive disease: a rare but potentially critical condition in patients undergoing pancreaticoduodenectomy.
abstract: OBJECTIVE
  Undiagnosed occlusive disease of celiac trunk and/or superior mesenteric artery may lead to life-threatening complications after pancreatoduodenectomy.
  
  
  METHODS
  Retrospective analysis of a consecutive series of 171 patients scheduled for pancreatico- duodenectomy or total pancreatectomy.
  
  
  RESULTS
  The prevalence of arterial occlusive disease was 5.9% (10 patients), including complete celiac artery occlusive disease in 2 patients (1.2%). Preoperative diagnosis was achieved in 90% of the patients by lateral-views of imaging studies. In arterial stenosis <50% (3 patients), abstention was always successful. In arterial stenosis >50%, successful treatment options included abstention (n=1), preoperative endovascular dilatation (n=1) or stenting (n=1), division of the median arcuate ligament with (n=1) or without (n=1) postoperative endovascular stenting, and aorto-hepatic bypass (2 patients). No early postoperative ischemic complications occurred. However, one patient died from late intestinal ischemia.
  
  
  CONCLUSIONS
  Arterial occlusive disease is rare in patients undergoing pancreatico-duodenectomy but expose the patient to severe complications if undiagnosed. A tailored management according to the type of arterial stenosis, to patients' indication for surgery and to patients' arterial anatomy is indicated. Surgical and endovascular management may be successfully combined.
authors.affiliation: Department of Abdominal Surgery and Transplantation, Saint-Luc University Hospital, Université Catholique de Louvain, Avenue Hippocrate, 10-1200, [corrected] Brussels, Belgium.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Ouassi
authors.forename: Mehdi
authors.initials: M
authors.lastname: Ouaissi
authors.forename: Robert
authors.initials: R
authors.lastname: Verhelst
authors.forename: Parla
authors.initials: P
authors.lastname: Astarci
authors.forename: Parla
authors.initials: P
authors.lastname: Astraci
authors.forename: Gébrine
authors.initials: G
authors.lastname: El Khoury
authors.forename: Catherine
authors.initials: C
authors.lastname: Hubert
authors.forename: Bernard E
authors.initials: BE
authors.lastname: van Beers
authors.forename: Bernard
authors.initials: B
authors.lastname: E van Beers
authors.forename: Laurence
authors.initials: L
authors.lastname: Annet
authors.forename: Pierre
authors.initials: P
authors.lastname: Goffette
authors.forename: Philippe
authors.initials: P
authors.lastname: Noirhomme
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Gigot
mesh_terms: D000368:Aged; D001157:Arterial Occlusive Diseases / Q000150:complications*; D002445:Celiac Artery; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D017538:Mesenteric Artery, Superior; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed