title: Classification of the celiac axis stenosis owing to median arcuate ligament compression, based on severity of the stenosis with subsequent proposals for management during pancreatoduodenectomy.
abstract: BACKGROUND
  After pancreatoduodenectomy in patients with celiac axis stenosis or obstruction, it becomes problematic to maintain the upper abdominal organ blood flow, especially to the liver. The aim of this study was to investigate the celiac axis stenosis caused by median arcuate ligament (MAL) compression and to classify it according to preoperative image findings.
  
  
  METHODS
  From January 1989 to November 2010, 562 patients underwent operations for diseases of the pancreatic head region in our department. To diagnose celiac artery compression by the MAL, angiography was used in the early period and 3-dimensional image reconstruction of multidetector-row computed tomography was used from 2004. The morphologic characteristics of the celiac axis stenosis were analyzed during intraoperative treatment.
  
  
  RESULTS
  Twelve (2.1%) patients were diagnosed with MAL compression, and 8 of these patients only underwent MAL division to restore the celiac artery blood flow. One patient required conservation of the collateral circulation, and 2 patients needed arterial reconstruction. In the analysis of the level of origin of the celiac axis, there were no remarkable differences between nonstenotic and stenotic cases, or between mild and severe stenotic cases. Morphologic grades were defined based on the preoperative image findings and consequent intraoperative treatments.
  
  
  CONCLUSIONS
  Preoperative grading of celiac axis stenosis could make pancreatoduodenectomy safer with maintenance of the upper abdominal organ blood flow in patients with MAL compression.
authors: Department of Surgery II, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors: Takashi
authors: T
authors: Sugae
authors: Tsutomu
authors: T
authors: Fujii
authors: Yasuhiro
authors: Y
authors: Kodera
authors: Akiyuki
authors: A
authors: Kanzaki
authors: Kazuo
authors: K
authors: Yamamura
authors: Suguru
authors: S
authors: Yamada
authors: Hiroyuki
authors: H
authors: Sugimoto
authors: Shuji
authors: S
authors: Nomoto
authors: Shin
authors: S
authors: Takeda
authors: Akimasa
authors: A
authors: Nakao
mesh_terms: D000368:Aged; D002445:Celiac Artery / Q000473:pathology* / Q000502:physiology; D003251:Constriction, Pathologic / Q000209:etiology / Q000473:pathology; D005260:Female; D006801:Humans; D008022:Ligaments / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications / Q000209:etiology* / Q000473:pathology; D012039:Regional Blood Flow