title: Pancreaticoduodenectomy in the presence of a common hepatic artery originating from the superior mesenteric artery. Technical implications.
abstract: Pancreaticoduodenectomy (PD) is considered a technically demanding task. Anatomic variations in duodenopancreatic vascularization [celiac axis and the superior mesenteric artery (SMA)] may carry a risk of potentially life-threatening vascular injury. We retrospectively report a modified PD technique performed in two patients presenting with a Common Hepatic Artery (CHA) originating from SMA. The CHA anatomical pattern was known prior surgical procedure. The main modification consisted in cutting pancreas prior dividing the CHA and the gastroduodenal artery. No intraoperative incident was reported. Perioperative outcomes were unremarkable, no vascular injury or hepatic ischemia was reported. Surgeons planning a PD must analyze in depth imaging (CT-scan with 3D angiography) and try to find these patterns. Furthermore, some rare arterial variations may be met and change typical surgical plan. Knowing prior procedure the arterial pattern and keeping in mind expendable or vital vessels allow to accomplish unusual but effective operations.
authors.affiliation: Service de Chirurgie Digestive, Hépatobiliaire et Pancréatique, Centre Hospitalier Simone Veil, Eaubonne, France; Service de Chirurgie Digestive, Hôpital Antoine Béclère, Assistance Publique - Hôpitaux de Paris, Clamart, Université Paris XI, France. Electronic address: alban.lebian@ch-simoneveil.fr.
authors.forename: Alban
authors.initials: A
authors.lastname: Zarzavadjian Le Bian
authors.affiliation: Service de Chirurgie Digestive, Hôpital Antoine Béclère, Assistance Publique - Hôpitaux de Paris, Clamart, Université Paris XI, France; Dipartimento di Scienze Chirurgiche, Università di Parma, Parma, Italy. Electronic address: renatocosti@hotmail.com.
authors.forename: Renato
authors.initials: R
authors.lastname: Costi
authors.affiliation: Service de radiologie diagnostique et interventionnelle, Centre Hospitalier Simone Veil, Eaubonne, France. Electronic address: sylvie.blangy@ch-simoneveil.fr.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Blangy
authors.affiliation: Service de Chirurgie Digestive, Hépatobiliaire et Pancréatique, Centre Hospitalier Simone Veil, Eaubonne, France. Electronic address: mohamed.sbai-idrissi@ch-simoneveil.fr.
authors.forename: Mohamed Saïd
authors.initials: MS
authors.lastname: Sbai-Idrissi
authors.affiliation: Service de Chirurgie Digestive, Hôpital Antoine Béclère, Assistance Publique - Hôpitaux de Paris, Clamart, Université Paris XI, France. Electronic address: claude.smadja@abc.aphp.fr.
authors.forename: Claude
authors.initials: C
authors.lastname: Smadja
mesh_terms: D000230:Adenocarcinoma / Q000098:blood supply / Q000601:surgery*; D000368:Aged; D000792:Angiography; D005260:Female; D006499:Hepatic Artery / Q000000981:diagnostic imaging*; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging*; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000098:blood supply / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D057772:Vascular System Injuries / Q000517:prevention & control*
keywords: Common hepatic artery; Pancreaticoduodenectomy; Vascular injury