Pancreaticoduodenectomy and arterial revascularization (right common iliac artery-common hepatic artery bypass) for pancreatic head carcinoma with a stricture of the celiac artery

Abstract

A 73-year-old woman with a chief complaint of abdominal discomfort was given a diagnosis of pancreas head cancer concomitant with celiac artery stenosis. Abdominal CT demonstrated stenosis with calcification at the root of the celiac artery, but 3-dimensional-CT angiogram images did not show a typical "hooked appearance" that is a characteristic of median arcuate ligament syndrome. Conventional angiogram revealed a focal narrowing of the celiac axis, hepatopetal blood flow from the superior mesenteric artery to the proper hepatic artery via the pancreatic arcade and the gastroduodenal artery, and hepatofugal blood flow to the common hepatic artery and the splenic artery. Pancreaticoduodenectomy with arterial reconstruction was performed out of consideration of stenosis caused by atherosclerosis or extrinsic compression. The surrounding tissue of the celiac axis was dissected and skeletonized, but the hepatic arterial flow did not improve. After reconstruction of the digestive tract, an arterial bypass using the greater saphenous vein was performed between the right common iliac artery and the common hepatic artery. The postoperative course was uneventful without complications. Intrahepatic arterial flow measurement using Doppler ultrasound was useful regarding convenience and stability. It is important to diagnose this disease preoperatively and plan arterial reconstruction during the pancreaticoduodenectomy procedure.