[Characteristics of anastomoses between the celiac trunk and the superior mesenteric artery]

Duodenum and pancreas are two deep abdominal viscerae with multiple arterial sources and complex vascular relations, that impose peculiar surgical techniques. The dissection of 120 corpses and the examination of selective angiographies revealed the variants of the anastomoses between the superior pancreaticoduodenal arteries (that receive blood from the celiac trunk) and the inferior pancreaticoduodenal arteries (belonging to the collateral subsystem of the superior mesenteric artery). The pancreaticoduodenal arches are the main anastomosis around the pancreatic head, and supply the duodeno-pancreatic complex. During this study I found the absence of this anastomosis of the antero-inferior duodenopancreatic arch 5 cases (4.16%), and the lack of anastomosis of the postero-superior duodenopancreatic arch in 11 cases (9.16%). In these situations, the superior and the inferior duodenopancreatic arteries give off the vasa recta and the pancreatic branches, as normally. I found different variants of accessory duodenopancreatic arches, and I analyzed their impact on the surgical techniques on duodenum and pancreas. This study pinpoints the importance of the anastomotic subsystem in the arterial supply of the duodeno-pancreatic complex, reveals the necessity of the preoperative angiographic exam in order to choose the most opportune surgical technique.