title: [Radiological-surgical methods to identify celiac-mesenteric anomalies of the hepatic artery before duodenopancreatectomy].
abstract: BACKGROUND
  Up to 45% anatomical variations are found in hepatic arterial system. Identifying these anatomical anomalies before or during surgery would prevent additional morbidity in performing a duodenopancreatectomy. They are routinely identified before surgery using CT imaging, but on certain occasions they are not reported and are only discovered during the surgical operation. The initial retroperitoneal access by the superior mesenteric artery (SMA) will avoid a fairly useless intervention if there is superior mesenteric artery invasion, and will identify the anatomical variations originating in the superior mesenteric artery. These anomalies acquire importance in that their unnoticed injury could lead to severe vascular compromise and/or perioperative bleeding.
  
  
  OBJECTIVE
  To analyse celiac-mesenteric anomalies of the hepatic artery before duodenopancreatectomy using the information from multidetector computed tomography (MDCT) using a non-standardised method, a standardised method with multidimensional reconstruction, and maximum intensity projection (MIP), after initial surgical access to the SMA.
  
  
  METHODS
  A retrospective study of the clinical, histopathological and surgical variables was conducted on patients with an indication for duodenopancreatectomy in our Department from 2008 until April 2010. A study was performed on the reports made after image acquisition by MDCT. A blind, three-dimensional, MIP reconstruction was performed on all the patients to identify arterial anomalies. A description is given of hepatic artery anomalies after initial access to the SMA.
  
  
  RESULTS
  A total of 61 patients were included in the study. The mean age was 65 ± 11 years, with 33 (54%) males and 28 (46%) females. Vascular anomalies, right hepatic artery (RHA) (SMA) substitute (subst), 5 (8%); RHA (SMA) accessory (acc), 4 (7%); left hepatic artery (LHA) (left gastric artery) (LGA) acc 3 (5%); common hepatic artery (CHA) (SMA) subst 3 (5%); RHA (SMA) acc+LHA (LGA) acc2 (3%); CHA (aorta) subst, 1 (2%); RHA+RGA+2 LHA (celiac trunk), 1 (2%); and CHA (SMA)+LHA (LGA) acc.
  
  
  CONCLUSIONS
  On being able to identify arterial anomalies with a mixture of preoperative radiological and methodological criteria, with three-dimensional reconstruction, MIP, and initially performing a dissection of the superior mesenteric artery could avoid duodenopancreatectomies that may not benefit the patient and compromise bleeding.
authors.affiliation: Servicio de Cirugía General y de Aparato Digestivo, Hospital General Universitario de Ciudad Real, España. marcote15@yahoo.es
authors.forename: David
authors.initials: D
authors.lastname: Padilla Valverde
authors.forename: Pedro
authors.initials: P
authors.lastname: Villarejo Campos
authors.forename: José
authors.initials: J
authors.lastname: Villanueva Liñán
authors.forename: Pablo
authors.initials: P
authors.lastname: Menéndez Sánchez
authors.forename: Teófilo
authors.initials: T
authors.lastname: Cubo Cintas
authors.forename: Jesús
authors.initials: J
authors.lastname: Martín Fernández
mesh_terms: D000368:Aged; D002445:Celiac Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging*; D005260:Female; D006499:Hepatic Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D017538:Mesenteric Artery, Superior / Q000002:abnormalities* / Q000000981:diagnostic imaging*; D061330:Multidetector Computed Tomography; D016577:Pancreaticoduodenectomy; D011300:Preoperative Care; D012189:Retrospective Studies