McCracken Emily, Turley Ryan, Cox Mitchell, Suhocki Paul, Blazer Dan German
Department of Surgery, Duke University Medical Center, Durham, North Carolina.
Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
J Pancreat Cancer. 2018 Jan 1;4(1):4-6. doi: 10.1089/pancan.2017.0020. eCollection 2018.
Celiac artery stenosis and occlusion have been described rarely in patients undergoing pancreaticoduodenectomy (PD), although it occurs relatively frequently in this group. An arterial connection between the celiac and superior mesenteric arteries, known as the Arc of Buhler, provides alternative flow to the celiac distribution once the gastroduodenal artery (GDA) is ligated in PD. A 69-year-old man, in whom pre- and intraoperative efforts to stent an occluded celiac artery failed, had sufficient retrograde flow from an unrecognized Arc of Buhler to maintain adequate hepatic arterial perfusion after ligation of the GDA during a PD. Although there are several case reports and case series regarding the management of celiac stenosis in PD, the impact of an Arc of Buhler variant in this setting has been rarely reported. This case report demonstrates the ability of an intact Arc of Buhler to maintain adequate hepatic perfusion after ligation of the GDA and avoid the potential morbidity of a hepatic artery bypass procedure.
虽然腹腔干狭窄和闭塞在接受胰十二指肠切除术（PD）的患者中相对常见，但相关描述却很少。腹腔干与肠系膜上动脉之间的动脉连接，即布勒尔弓，在PD中结扎胃十二指肠动脉（GDA）后，可为腹腔干分布区提供替代性血流。一名69岁男性患者，术前和术中对闭塞的腹腔干进行支架置入的尝试均失败，但在PD期间结扎GDA后，来自未被识别的布勒尔弓的逆行血流足以维持肝脏的充分动脉灌注。虽然有几篇关于PD中腹腔干狭窄处理的病例报告和病例系列，但在这种情况下布勒尔弓变异的影响鲜有报道。本病例报告展示了完整的布勒尔弓在结扎GDA后维持肝脏充分灌注以及避免肝动脉搭桥手术潜在并发症的能力。
