Not Just for Ligation: Repurposing the Gastroduodenal Artery as a Vascular Conduit During Pancreaticoduodenectomy

In a standard pancreaticoduodenectomy (Whipple procedure), the gastroduodenal artery (GDA) is ligated. In a patient with celiac axis occlusion with prominent GDA collaterals, the decision of whether to preserve the GDA comes into play. We report the case of an otherwise healthy 60-year-old woman who presented with a pancreatic mass with concurrent celiac axis occlusion. Pre-operative imaging illustrated a celiac axis occlusion with prominent collaterals from the gastroduodenal artery supplying the distal pancreas, spleen, and stomach. Arteriography further demonstrated a replaced right hepatic artery originating from the superior mesenteric artery and a diminutive left hepatic artery. Based on these findings, the decision was made to re-implant the gastroduodenal artery to preserve the aforementioned structures. Thus far, there have been no instances of GDA re-implantation in the literature. A review of the literature was performed using PubMed, Embase, and Google Scholar with search terms including 'gastroduodenal artery reimplantation,' 'GDA reconstruction,' 'Whipple,' 'pancreaticoduodenectomy,' and 'celiac axis occlusion.' To our knowledge, no prior reports of gastroduodenal artery re-implantation during pancreaticoduodenectomy have been identified.