Managing arterial collaterals due to coeliac axis stenosis during pancreaticoduodenectomy

Coeliac artery stenosis is a condition affecting a minority of patients undergoing pancreaticoduodenectomy. In such cases, the development of collateral pathways through the blood supply of the pancreatic head provides challenges for surgical management.

We report a case of coeliac artery stenosis in a patient undergoing pancreaticoduodenectomy. The main blood supply for the coeliac axis was through a single collateral channel, formed by the anterior pancreaticoduodenal arterial arcade. We describe the preservation of this arcade, resection of the redundant artery with primary anastomosis and a review of the literature.

Management of coeliac artery stenosis during pancreaticoduodenectomy depends on identifying the cause and dealing with it accordingly, intraoperatively.