Figure 5 - available via license: CC BY-NC-ND
Content may be subject to copyright.
PG's CT-perfusion image: 1 -recipient's common iliac artery, 2 -arterial graft, 3 e splenic artery, 4 -intraorganic arterial collaterals.
Source publication
Background:
The blood supply of the native pancreas by three arterial lines from the celiac trunk system (splenic artery and common hepatic artery) and the superior mesenteric artery forces surgeons to perform vascular reconstruction to provide sufficient intra-organ blood flow into the graft. The purpose of our study was to assess the possibility...
Context in source publication
Context 1
... results of histological studies of biopsy specimens. 3D CTreconstruction with contrast enhancement and CTperfusion enabled us to prove objectively the sufficient vascularization of the PG's parenchyma in the study groups and uniform blood supply of the transplant through the collaterals system between the splenic and superior mesenteric arteries (Fig. 5). Quantitative assessment of intra-organ blood flow demonstrated a sufficient level of blood supply to the organ with both functioning arteries and with SA alone. In our clinical observations, the mean rates of blood flow in transplants in all three groups did not differ significantly (Table ...
Similar publications
While treating vascular aneurysms with endovascular technique, short neck and severe bending of the artery are one of the biggest challenges, whether choosing coil embolization or stent-graft (SG) deployment. Here, we report a case with large aneurysm of the splenic artery, which had anomalistically arisen from the superior mesenteric artery and ha...
Citations
... As Pinchuk et al. stated, the arteries in the pancreas form a complex arcade, and in some cases, imaging studies of the entire pancreas can be obtained by injecting a contrast medium through the splenic artery [17]. However, some grafts do not have a sufficiently developed arcade. ...
Maintenance of postoperative graft flow is important in pancreas transplantation. In Japan, reconstruction of the common hepatic artery is performed primarily to increase perfusion in the pancreatic head. We investigated the effects of common hepatic artery reconstruction on patient and graft survival and endocrine functions. Twenty-nine cases of pancreas transplantation were registered in the clinical trial. Of the 29 cases, four were excluded because of the risk of ischemia without reconstruction or complicated reconstruction due to a narrow artery. A total of 25 cases were randomized into two groups: 13 in the non-reconstructed group and 12 in the reconstructed group. The 1-year patient survival and graft survival rates of the non-reconstructed and reconstructed groups were 92.3% and 83.3%, and 91.7% and 82.5%, respectively. The incidence of complications in the two groups was comparable, with 38.5% (5/13 cases) in the non-reconstructed group and 33.3% (4/12 cases) in the reconstructed group. The results of the glucagon stimulation test and oral glucose tolerance test at 1 month and 1 year post-transplantation were comparable. Common hepatic artery reconstruction is not essential unless there is risk of ischemia. This study was registered at the University Hospital Medical Information Network Clinical Trials Registry under UMIN000027213.
... Сосудистых осложнений у реципиентов обеих групп не наблюдалось. При контрольной МСКТ панкреатодуоденального трансплантата статистически значимых различий в параметрах объемного кровотока в контрольной группе и группе сравнения выявлено не было [21]. ...
About 2,400 pancreas transplantations are performed every year worldwide, mainly pancreaticoduodenal transplantations. Most clinics use the classical revascularization technique using a Y-shaped vascular prosthetic implant. However, it is not always possible to restore full blood supply to the graft in this way. Therefore, other options for arterial reconstruction are being developed - from isolated blood supply to the graft via the splenic artery to full blood flow restoration through all the main vessels of the organ to ensure the most physiological blood supply to the pancreas. This review is devoted to analysis of the used arterial reconstruction methods and pancreaticoduodenal graft revascularization techniques.
Pancreas transplant (PTx), one of the most complicated, unpredictable, and resource- and energy-consuming types of solid organ transplant, has a long history in Russia, but overall transplant numbers remain small. As of January 1, 2021, a total of 210 PTx in various technical modifications have been performed at 9 transplant centers in the Russian Federation. PTx is most often carried out in patients with end-stage renal disease (ESRD) due to diabetic nephropathy, simultaneous pancreas and kidney (SPK) transplants, and pancreas procured from deceased donors. Although the vast majority of PTx are whole-organ SPK transplants from deceased donors, at least 13 PTx from living donors were performed: 11 pancreas transplants alone (PTAs) and 2 SPK transplants. Approximately 93% of PTx were performed at the three leading transplant hospitals in Moscow. A trend toward an increase in the number of PTx at regional transplant centers has been observed, and there are six other Russian transplant centers where PTx have been performed. Healthcare authorities and the medical and transplant communities at large are determined to establish PTx in the Russian Federation as a more widely available, viable, and accessible treatment option for insulin-dependent patients with or without ESRD.
The variability of vascular anatomy of the pancreas underlines the difficulty of its transplantation. Research regarding the consistency of anatomical variations shows splenic arterial dominance in most cases. This can significantly improve transplantation success. A systematic literature review was performed according to the quality standards described in the AMSTAR measurement tool and the PRISMA guidelines. We valuated existing literature regarding the vascularization and blood perfusion patterns of the pancreas in terms of dominance and variability. The collected data was independently analyzed by two researchers. Variance of vascular anatomy was seen to be underreported in literature, though significant findings have been included and discussed in this study, providing valuable insight into the dynamics of pancreatic perfusion and feasibility of transplantation on several different supplying arteries. The splenic artery (SA) has a high percentage of consistency in all found studies (over 90%). High frequency of anastomoses between arterial pools supplying the pancreas can mediate sufficient blood supply through a dominant vessel, such as the SA, which is present in most cases. Pancreatic transplantation with isolated SA blood supply can provide sufficient arterial perfusion of the pancreas for stable transplant viability due to high anatomical consistency of the SA and vast communications with other arterial systems.
Whole organ pancreas transplantation is a validated technique of the management of insulin sensitive diabetes and its complications. While several techniques have been described for this procedure that carries a significant morbidity and small mortality risk, surgery requires adequately sized vessels to implant the organ. In this paper, the authors describe a novel technique of implantation of the pancreas onto the splenic vessels with concomitant splenic preservation or other visceral vessels that they have employed when traditional implantation sites are not suitable with successful outcome on long term follow up.
