Background/Objectives: Celiac axis stenosis (CAS) represents an uncommon and typically innocuous condition. However, when a pancreatic resection is required, a high risk for upper abdominal organs ischemia is observed. In presence of collaterals, such a risk is minimized if their preservation is realized. The aim of the present study is to systematically review the literature with the intent to address the routine management of collateral arteries in the case of CAS patients requiring pancreatoduodenectomy. Methods: A systematic search was done in accordance with the PRISMA guidelines, using “celiac axis stenosis” AND “pancreatoduodenectomy” as MeSH terms. Seventy-four articles were initially screened: eventually, 30 articles were identified (n = 87). Results: The main cause of CAS was median arcuate ligament (MAL) (n = 31; 35.6%), followed by atherosclerosis (n = 20; 23.0%). CAS was occasionally discovered during the Whipple procedure in 15 (17.2%) cases. Typically, MAL was divided during surgery (n = 24/31; 77.4%). In the great majority of cases (n = 83; 95.4%), vascular abnormalities involved the pancreatoduodenal arteries (i.e., dilatation, arcade, channels, aneurysms). Collateral arteries were typically preserved, being divided or reconstructed in only 14 (16.1%) cases, respectively. Severe ischemic complications were reported in six (6.9%) patients, 20.0% of whom were reported in patients with preoperatively unknown CAS (p-value 0.06). Conclusions: A correct pre-operative evaluation of anatomical conditions as well as a correct surgical planning represent the paramount targets in CAS patients with arterial collaterals. Vascular flow must be always safeguarded preserving/reconstructing the collaterals or resolving the CAS, with the final intent to avoid dreadful intra- and post-operative complications.

Collaterals management during pancreatoduodenectomy in patients with celiac axis stenosis. A systematic review of the literature / Giovanardi, Francesco; Lai, Quirino; Garofalo, Manuela; Arroyo Murillo, Gabriela A.; Choppin de Janvry, Eleonore; Hassan, Redan; Larghi Laureiro, Zoe; Consolo, Adriano; Melandro, Fabio; Berloco, Pasquale B.. - In: PANCREATOLOGY. - ISSN 1424-3903. - 18:(2018), pp. 592-600. [10.1016/j.pan.2018.05.003]

Collaterals management during pancreatoduodenectomy in patients with celiac axis stenosis. A systematic review of the literature

Giovanardi, Francesco
;
Lai, Quirino;Garofalo, Manuela;Arroyo Murillo, Gabriela A.;Hassan, Redan;Larghi Laureiro, Zoe;Consolo, Adriano;Melandro, Fabio;Berloco, Pasquale B.
2018

Abstract

Background/Objectives: Celiac axis stenosis (CAS) represents an uncommon and typically innocuous condition. However, when a pancreatic resection is required, a high risk for upper abdominal organs ischemia is observed. In presence of collaterals, such a risk is minimized if their preservation is realized. The aim of the present study is to systematically review the literature with the intent to address the routine management of collateral arteries in the case of CAS patients requiring pancreatoduodenectomy. Methods: A systematic search was done in accordance with the PRISMA guidelines, using “celiac axis stenosis” AND “pancreatoduodenectomy” as MeSH terms. Seventy-four articles were initially screened: eventually, 30 articles were identified (n = 87). Results: The main cause of CAS was median arcuate ligament (MAL) (n = 31; 35.6%), followed by atherosclerosis (n = 20; 23.0%). CAS was occasionally discovered during the Whipple procedure in 15 (17.2%) cases. Typically, MAL was divided during surgery (n = 24/31; 77.4%). In the great majority of cases (n = 83; 95.4%), vascular abnormalities involved the pancreatoduodenal arteries (i.e., dilatation, arcade, channels, aneurysms). Collateral arteries were typically preserved, being divided or reconstructed in only 14 (16.1%) cases, respectively. Severe ischemic complications were reported in six (6.9%) patients, 20.0% of whom were reported in patients with preoperatively unknown CAS (p-value 0.06). Conclusions: A correct pre-operative evaluation of anatomical conditions as well as a correct surgical planning represent the paramount targets in CAS patients with arterial collaterals. Vascular flow must be always safeguarded preserving/reconstructing the collaterals or resolving the CAS, with the final intent to avoid dreadful intra- and post-operative complications.
2018
Hepatic abscess;liver ischemia; median arcuate ligament; pancreatoduodenal arcades; splanchnic aneurysm; endocrinology, diabetes and metabolism; Hepatology; Gastroenterology
01 Pubblicazione su rivista::01g Articolo di rassegna (Review)
Collaterals management during pancreatoduodenectomy in patients with celiac axis stenosis. A systematic review of the literature / Giovanardi, Francesco; Lai, Quirino; Garofalo, Manuela; Arroyo Murillo, Gabriela A.; Choppin de Janvry, Eleonore; Hassan, Redan; Larghi Laureiro, Zoe; Consolo, Adriano; Melandro, Fabio; Berloco, Pasquale B.. - In: PANCREATOLOGY. - ISSN 1424-3903. - 18:(2018), pp. 592-600. [10.1016/j.pan.2018.05.003]
File allegati a questo prodotto
File Dimensione Formato  
Giovanardi_Celiac-axis-stenosis_2018.pdf

solo gestori archivio

Tipologia: Versione editoriale (versione pubblicata con il layout dell'editore)
Licenza: Tutti i diritti riservati (All rights reserved)
Dimensione 1.7 MB
Formato Adobe PDF
1.7 MB Adobe PDF   Contatta l'autore

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1115255
Citazioni
  • ???jsp.display-item.citation.pmc??? 5
  • Scopus 10
  • ???jsp.display-item.citation.isi??? 9
social impact