Anatomy of the pancreatic vasculature:respect of the duodenum preserving resection of head of pancreas

Abstract

INTRODUCTION: Duodenum preserving resection of the head of the pancreas is performed mostly in chronic pancreatitis. Knowledge of precise anatomy of the pancreaticoduodenal region especially of the pancreaticoduodenal arteries, which provide blood to the duodenum, is mandatory for safe surgery. MATERIALS AND METHODS: Twenty human cadavers (age 56-87 years) of both sexes (10 males: 10 females) were studied with relevance to the anatomy of the head of the pancreas and duodenum in relation of the regional vascular arcades.RESULTS: The gastroduodenal artery (GDA) originates 3.7cm (3.1cm 5.1cm) from celiac trunk from the common hepatic artery. The Emergence of anterior superior pancreaticoduodenal artery (ASPA) was at 3.4cm (2.9cm - 4.2cm) of the origin of the gastroduodenal artery. After departing from gastroduodenal artery ASPA runs downwards along the medial side of the 2nd part of the duodenum and turned to the posterior aspect of the pancreas to join the anterior inferior pancreaticoduodenal artery (AIPA). Arcade formation between the ASPA and AIPA was found in all cadavers. Posterior superior pancreaticoduodenal artery (PSPA) originates 2.1 cm (1.8cm-2.8cm) from the origin of the gastroduodenal artery. PSPA form an arterial arcade with the branches of the posterior inferior pancreaticoduodenal artery. Posterior vascular arcade always located posterior to the common bile duct. Anterior and posterior vascular arcades were 0.35cm (0.32 cm 0.43cm) and 0.24 cm (0,21 cm 0.34cm) medial to the medial border of the duodenum respectively. CONCLUSION: In duodenal preserving pancreatic surgery, the knowledge of this complex vascularization will help to preserve arterial arcades around head of the pancreas while performing pan create cto my.