Perioperative risk assessment and multidisciplinary intervention strategies for pancreaticoduodenectomy in patients with celiac axis stenosis
WEI Ji-shu
Abstract：Celiac axis stenosis(CAS)is one of the risk factors for severe complications following pancreaticoduodenectomy(PD).CAS is significantly associated with complications such as pancreatic fistula,bile leakage,hepatic ischemia,and delayed gastric emptying,and may increase perioperative mortality.The diagnosis of CAS primarily relies on CT,MRI or angiography,with a stenosis＞50％confirming the diagnosis.Its etiology is categorized into extraluminal compression(e.g.,median arcuate ligament compression)and intraluminal lesions(e.g.,atherosclerotic plaques).As the aging population increases,the proportion of CAS related to atherosclerosis has significantly risen.Notably,CAS is often coexistent with superior mesenteric artery(SMA)stenosis,where collateral circulation relies on the blood vessels in the pancreatic head region(e.g.,gastroduodenal artery,GDA)to maintain blood supply to the celiac artery.During PD,transection of the GDA disrupts the collateral circulation,leading to ischemia of the liver,spleen,and remnant pancreas,thereby causing severe complications.Management strategies for CAS should be individualized.Preoperative imaging evaluation should focus on signs of narrowing at the celiac artery origin and abnormal vasculature in the pancreatic head region.For CAS caused by arterial plaques,endovascular stent placement or balloon dilation may be considered;for median arcuate ligament compression,ligament release surgery should be performed intraoperatively.If CAS is discovered intraoperatively,the GDA may be preserved or vascular reconstruction(such as celiac artery reimplantation)may be performed.For cases where the GDA cannot be preserved,postoperative vigilance for liver,spleen,and remnant pancreas is crucial,with timely vascular intervention if needed.Although some cases have been reported to recover without intervention,multivariate analysis indicates that severe CAS is an independent risk factor for postoperative hepatic hypoperfusion and pancreatic fistula.With the increasing proportion of elderly individuals in China,the number of pancreatic disease patients concomitant with CAS is expected to rise.Pancreatic surgeons should strengthen preoperative imaging assessments,identify CAS early,and develop intervention strategies to reduce the risk of postoperative complications.Multidisciplinary collaboration and the establishment of standardized treatment protocols are crucial directions for optimizing outcomes in these patients in the future.
Keywords：celiac axis stenosispancreaticoduodenectomymedian arcuate ligament compressionatherosclerosispostoperative complications
Publication Date：2025-03-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：5( 274-278 )