title: Replaced gastroduodenal artery: Added benefit of the "artery first" approach during pancreaticoduodenectomy-A case report.
abstract: BACKGROUND
  Variations in hepatic arterial anatomy are frequently encountered in pancreas and liver surgery. These aberrancies add technical complexity to the procedure and can result in significant patient morbidity if these vascular nuances are not recognized.
  
  
  METHODS
  We report a case whereby a superior mesenteric artery first approach was used to locate and preserve an aberrant left hepatic artery arising from a replaced gastroduodenal artery emanating from the SMA during pancreaticoduodenectomy. The procedure was done for resection of a large duodenal adenoma.
  
  
  CONCLUSIONS
  High-quality preoperative imaging and mastery in surgical expertise are requirements for identification and preservation of aberrant hepatic arterial anatomy during procedures involving vital intra-abdominal organs.
  
  
  CONCLUSIONS
  Our aim is to provide awareness of rare vascular anomalies encountered during pancreaticoduodenectomy and provide a unique method for successful management.
authors.affiliation: Pancreatic Cancer Program, Medical College of Wisconsin, Department of Surgery, Division of Surgical Oncology, Milwaukee, WI, United States.
authors.forename: George
authors.initials: G
authors.lastname: Younan
authors.affiliation: Pancreatic Cancer Program, Medical College of Wisconsin, Department of Surgery, Division of Surgical Oncology, Milwaukee, WI, United States.
authors.forename: Munyaradzi
authors.initials: M
authors.lastname: Chimukangara
authors.affiliation: Pancreatic Cancer Program, Medical College of Wisconsin, Department of Surgery, Division of Surgical Oncology, Milwaukee, WI, United States.
authors.forename: Susan
authors.initials: S
authors.lastname: Tsai
authors.affiliation: Pancreatic Cancer Program, Medical College of Wisconsin, Department of Surgery, Division of Surgical Oncology, Milwaukee, WI, United States.
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Evans
authors.affiliation: Pancreatic Cancer Program, Medical College of Wisconsin, Department of Surgery, Division of Surgical Oncology, Milwaukee, WI, United States. Electronic address: kchristi@mcw.edu.
authors.forename: Kathleen K
authors.initials: KK
authors.lastname: Christians
keywords: Artery first; Pancreaticoduodenectomy; Replaced gastroduodenal artery