Celiac Axis Stenosis in Pancreatoduodenectomy: Preoperative Predictors for Intervention Considering Stenosis Severity and Collateral Pathway Development.

backgroundCeliac axis stenosis (CAS) is a significant vascular condition in patients undergoing pancreatoduodenectomy due to division of the celiac circulation during the procedure. However, the reliable conditions for when to intervene remain undefined.

methodsWe retrospectively analyzed 1,042 consecutive patients who underwent pancreatoduodenectomy. The stenosis diameter and maximum diameter of the celiac axis were measured on preoperative multidetector CT to calculate the stenosis rate (SR). In the patients with CAS (SR ≥ 50%), two additional CT-based markers of arcade development were quantified: 1) the gastroduodenal-to-common hepatic artery diameter (GDA/CHA) ratio and 2) the diameter of the collateral artery connecting the GDA and inferior pancreatoduodenal artery. Four factors (stenosis diameter ≤2 mm, SR ≥70%, GDA/CHA ratio ≥1.0, collateral artery diameter ≥3 mm) were assessed as predictors of intraoperative intervention.

resultsEighty-five patients (8.2%) had CAS (SR ≥50%), of which only 11 (1.1% of the entire cohort) required intervention: median arcuate ligament division (n = 4), arterial reconstruction (n = 5), or collateral preservation (n = 2). Each of the four factors (stenosis diameter ≤2 mm, SR ≥70%, GDA/CHA ratio ≥1.0, collateral artery diameter ≥3 mm) was associated with the need for intervention. Intervention for CAS was not required in any case in which none of the four factors were present. In contrast, all patients with three or more positive factors required intervention.

conclusionsThe four factors (stenosis diameter, SR, GDA/CHA ratio, and collateral artery diameter) may serve as important predictors of CAS intervention. Incorporating these factors into preoperative planning enables surgeons to prepare necessary resources.