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1.
World J Gastroenterol ; 30(17): 2311-2320, 2024 May 07.
Article in English | MEDLINE | ID: mdl-38813054

ABSTRACT

Contrast-enhanced endoscopic ultrasound (CH-EUS) can overcome the limitations of endoscopic ultrasound-guided acquisition by identifying microvessels inside inhomogeneous tumours and improving the characterization of these tumours. Despite the initial enthusiasm that oriented needle sampling under CH-EUS guidance could provide better diagnostic yield in pancreatic solid lesions, further studies did not confirm the supplementary values in cases of tissue acquisition guided by CH-EUS. This review details the knowledge based on the available data on contrast-guided procedures. The indications for CH-EUS tissue acquisition include isoechoic EUS lesions with poor visible delineation where CH-EUS can differentiate the lesion vascularisation from the surrounding parenchyma and also the mural nodules within biliopancreatic cystic lesions, which occur in select cases. Additionally, the roles of CH-EUS-guided therapy in patients whose pancreatic fluid collections or bile ducts that have an echogenic content have indications for drainage, and patients who have nonvisualized vessels that need to be highlighted via Doppler EUS are presented. Another indication is represented if there is a need for an immediate assessment of the post-radiofrequency ablation of pancreatic neuroendocrine tumours, in which case CH-EUS can be used to reveal the incomplete tumour destruction.


Subject(s)
Contrast Media , Endosonography , Pancreatic Neoplasms , Humans , Contrast Media/administration & dosage , Pancreatic Neoplasms/diagnostic imaging , Pancreatic Neoplasms/surgery , Pancreatic Neoplasms/pathology , Endosonography/methods , Pancreas/diagnostic imaging , Pancreas/surgery , Pancreas/blood supply , Pancreas/pathology , Endoscopic Ultrasound-Guided Fine Needle Aspiration/methods , Ultrasonography, Interventional/methods , Drainage/methods , Pancreatic Diseases/diagnostic imaging , Pancreatic Diseases/surgery , Pancreatic Diseases/pathology
2.
Sci Rep ; 14(1): 10136, 2024 05 02.
Article in English | MEDLINE | ID: mdl-38698049

ABSTRACT

Exocrine and endocrine pancreas are interconnected anatomically and functionally, with vasculature facilitating bidirectional communication. Our understanding of this network remains limited, largely due to two-dimensional histology and missing combination with three-dimensional imaging. In this study, a multiscale 3D-imaging process was used to analyze a porcine pancreas. Clinical computed tomography, digital volume tomography, micro-computed tomography and Synchrotron-based propagation-based imaging were applied consecutively. Fields of view correlated inversely with attainable resolution from a whole organism level down to capillary structures with a voxel edge length of 2.0 µm. Segmented vascular networks from 3D-imaging data were correlated with tissue sections stained by immunohistochemistry and revealed highly vascularized regions to be intra-islet capillaries of islets of Langerhans. Generated 3D-datasets allowed for three-dimensional qualitative and quantitative organ and vessel structure analysis. Beyond this study, the method shows potential for application across a wide range of patho-morphology analyses and might possibly provide microstructural blueprints for biotissue engineering.


Subject(s)
Imaging, Three-Dimensional , Multimodal Imaging , Pancreas , Animals , Imaging, Three-Dimensional/methods , Pancreas/diagnostic imaging , Pancreas/blood supply , Swine , Multimodal Imaging/methods , X-Ray Microtomography/methods , Islets of Langerhans/diagnostic imaging , Islets of Langerhans/blood supply , Tomography, X-Ray Computed/methods
3.
J Surg Res ; 298: 149-159, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38608426

ABSTRACT

INTRODUCTION: Bench surgery for the preparation of deceased donor pancreatic grafts is labor-intensive and time-consuming. We hypothesized that energy devices could be used during bench surgery to decrease the bench surgery time. However, because bench surgery has two unique characteristics, wet conditions and no blood flow in the vessels, it is necessary to verify the safety and efficacy under such conditions. METHODS: In an animal tissue model, we validated both ultrasonic and bipolar energy devices: Harmonic Shears and the LigaSure (LS) vessel-sealing device by evaluating heat spread and pressure resistance under bench surgery conditions. In a clinical evaluation of the LS, we compared the outcomes of 22 patients in two different bench surgery groups: with and without the use of the LS. RESULTS: Clinically, the bench surgery time was significantly shorter in the LS group than that in the conventional group (P < 0.001). In the animal tissue experiments, the highest temperature in bench surgery conditions was 60.4°C after 1 s at a 5-mm distance in the LS group. Pressure resistance of ≥ 750 mmHg was achieved in almost all trials in both veins and arteries, with no difference between Harmonic Shears and LS. There was more surgical smoke visually in bench conditions versus in dry conditions and under half bite versus full bite conditions. CONCLUSIONS: The encouraging results of our exploratory clinical and animal studies of the energy devices suggest that they may be useful in the setting of bench surgery.


Subject(s)
Pancreas Transplantation , Animals , Pancreas Transplantation/instrumentation , Pancreas Transplantation/methods , Pancreas Transplantation/adverse effects , Humans , Male , Female , Adult , Middle Aged , Models, Animal , Swine , Pancreas/surgery , Pancreas/blood supply
4.
J Med Imaging Radiat Oncol ; 68(3): 289-296, 2024 Apr.
Article in English | MEDLINE | ID: mdl-38437188

ABSTRACT

INTRODUCTION: Sutton-Kadir Syndrome (SKS) describes true inferior pancreaticoduodenal artery (IPDA) aneurysms in the setting of coeliac artery (CA) stenosis or occlusion. Although rare, SKS aneurysms can rupture and cause morbidity. Due to its rarity and lack of controlled treatment data, correct treatment for the CA lesion is currently unknown. Our aim was to assess if endovascular embolisation alone was safe and effective in treatment of SKS aneurysms, in emergent and elective settings. Secondary objectives were to describe presentation and imaging findings. METHODS: A retrospective cohort study of patients treated at Sir Charles Gairdner Hospital between January 2014 and December 2021 was done. Data on presentation, diagnostics, aneurysm characteristics, CA lesion aetiology, treatment and outcomes were extracted from chart review. RESULTS: Twenty-four aneurysms in 14 patients were identified. Rupture was seen in 7/15 patients. Most aneurysms (22/24) were in the IPDA or one of its anterior or posterior branches. Median arcuate ligament (MAL) compression was identified in all. There was no difference in median (IQR) maximal transverse diameter between ruptured and non-ruptured aneurysms (6 mm (9), 12 mm (6), P = 0.18). Of ruptures, 6/7 had successful endovascular embolisation and 1/7 open surgical ligation. Of non-ruptures, 6/7 had successful endovascular embolisation, 1/7 open MAL division then endovascular CA stenting and aneurysm embolisation. No recurrences or new aneurysms were detected with computed tomography or magnetic resonance angiography over a median (IQR) follow-up period of 30 (10) months in 12 patients. CONCLUSION: Endovascular embolisation of SKS aneurysms without treatment of MAL compression is safe and effective in both the emergent and elective settings.


Subject(s)
Embolization, Therapeutic , Endovascular Procedures , Humans , Embolization, Therapeutic/methods , Retrospective Studies , Female , Male , Middle Aged , Endovascular Procedures/methods , Celiac Artery/diagnostic imaging , Aneurysm/diagnostic imaging , Aneurysm/therapy , Aged , Duodenum/blood supply , Duodenum/diagnostic imaging , Adult , Pancreas/blood supply , Pancreas/diagnostic imaging , Treatment Outcome , Aneurysm, Ruptured/diagnostic imaging , Aneurysm, Ruptured/therapy
5.
Transplant Proc ; 56(2): 456-458, 2024 Mar.
Article in English | MEDLINE | ID: mdl-38320871

ABSTRACT

In classic pancreatic transplantation, the splenic artery and vein are ligated at the tail of the pancreas graft. This leads to slowed blood flow in the splenic vein and may cause thrombosis and graft loss. In this study, a patient received a pancreas after kidney transplantation. A modified surgical technique was used in the pancreatic graft preparation. The donor splenic artery and vein were anastomosed end to end at the tail of the pancreas. The splenic artery near the anastomosis was partially ligated, and an effective diameter of 2 mm was reserved to limit arterial blood pressure and flow. The patient recovered very well. Contrasted computed tomography scans on days 11 and 88 after pancreas transplantation indicated sufficient backflow of the splenic vein. We believe that this procedure may avoid the risk of splenic vein thrombosis after pancreas transplantation. This modified technique has not been reported in clinical cases previously and may help reduce the risk of thrombosis after pancreas transplantation.


Subject(s)
Arteriovenous Fistula , Pancreas Transplantation , Thrombosis , Humans , Pancreas Transplantation/adverse effects , Pancreas Transplantation/methods , Pancreas/blood supply , Thrombosis/diagnostic imaging , Thrombosis/etiology , Thrombosis/surgery , Spleen , Splenic Vein/diagnostic imaging , Splenic Vein/surgery , Splenic Artery/diagnostic imaging , Splenic Artery/surgery
7.
Exp Clin Transplant ; 22(1): 52-62, 2024 Jan.
Article in English | MEDLINE | ID: mdl-38284375

ABSTRACT

OBJECTIVES: Pancreas transplant is currently the most effective method for maintaining physiological blood sugar levels and reversing small blood vessel injuries. Our team developed a model of whole pancreas transplant based on microsurgical techniques following the investigation of more than 300 mice. MATERIALS AND METHODS: A mouse pancreatic transplant model is required to investigate the pathophysiological process of pancreas transplant and pancreatic preservation technologies. Recently, the segment-neck pancreas transplant has been the most utilized mouse pancreatic transplant model. The innovative mouse pancreatic transplant modelthat we developed in this study uses the whole pancreas and returns heart blood flow into the liver via the portal vein. RESULTS: With our mouse pancreatic transplant model, the survivalrate of mice aftertransplant was >80%, and the success rate of pancreatic transplant was >90%. CONCLUSIONS: The segment-neck and the whole pancreas model can guarantee that the transplanted pancreas functions effectively, and both have excellent postoperative outcomes, survivalrates and pancreatic active rates.


Subject(s)
Pancreas Transplantation , Portal Vein , Animals , Mice , Portal Vein/surgery , Pancreas Transplantation/adverse effects , Pancreas Transplantation/methods , Pancreas/surgery , Pancreas/blood supply , Liver
8.
Vasc Endovascular Surg ; 58(2): 213-217, 2024 Feb.
Article in English | MEDLINE | ID: mdl-37635365

ABSTRACT

PURPOSE: To highlight median arcuate ligament syndrome as a potential cause for celiac artery stenosis and pancreaticoduodenal artery aneurysm, and describe treatment options in this setting. CASE REPORT: A 63-year-old male presented with a pancreaticoduodenal artery aneurysm and concomitant celiac artery stenosis that was treated with celiac artery stenting and aneurysm coiling. He subsequently developed stent fracture and celiac artery occlusion secondary to previously unrecognized median arcuate ligament syndrome causing reperfusion of the aneurysm. This was treated with open median arcuate ligament release and aorta to common hepatic artery bypass with good clinical result and stable 20-month surveillance imaging. CONCLUSION: It is critical to recognize median arcuate ligament syndrome as a cause of celiac artery stenosis in the setting of pancreaticoduodenal artery aneurysm given the high risk of failure of endovascular stenting. Open aorto-hepatic artery bypass and endovascular aneurysm coiling should be the preferred approach in these patients.


Subject(s)
Aortic Aneurysm, Abdominal , Blood Vessel Prosthesis Implantation , Embolization, Therapeutic , Endovascular Procedures , Median Arcuate Ligament Syndrome , Male , Humans , Middle Aged , Median Arcuate Ligament Syndrome/complications , Median Arcuate Ligament Syndrome/diagnostic imaging , Median Arcuate Ligament Syndrome/surgery , Constriction, Pathologic/complications , Constriction, Pathologic/surgery , Aortic Aneurysm, Abdominal/surgery , Pancreas/diagnostic imaging , Pancreas/blood supply , Embolization, Therapeutic/methods , Treatment Outcome , Celiac Artery/diagnostic imaging , Celiac Artery/surgery
10.
World J Surg ; 47(11): 2846-2856, 2023 11.
Article in English | MEDLINE | ID: mdl-37700108

ABSTRACT

BACKGROUND: Whole pancreas transplantation provides durable glycemic control and can improve survival rate; however, it can carry an increased risk of surgical complications. One devastating complication is a duodenal leak at the site of enteroenteric anastomosis. The gastroduodenal artery (GDA) supplies blood to the donor duodenum and pancreas but is commonly ligated during procurement. Since we have not had expressive changes in pancreatic back table surgical techniques in the recent decades, we hypothesized whether back table GDA reconstruction, improving perfusion of the donor duodenum and head of the pancreas, could lead to fewer surgical complications in simultaneous pancreas-kidney (SPK) transplants. MATERIAL AND METHODS: Between 2017 and 2021, we evaluated demographic information, postoperative complications, intraoperative donor duodenum, recipient bowel O2 tissue saturation, and patient morbidity through the Comprehensive Complication Index (CCI®). RESULTS: A total of 26 patients were included: 13 underwent GDA reconstruction (GDA-R), and 13 had GDA ligation (GDA-L). There were no pancreatic leaks in the GR group compared to 38% (5/13) in the GDA-L group (p = 0.03913). Intraoperative tissue oxygen saturation was higher in the GDA-R group than in the GDA-L (95.18 vs.76.88%, p < 0,001). We observed an increase in transfusion rate in GDA-R (p < 0.05), which did not result in a higher rate of exploration (p = 0.38). CCI® patient morbidity was also significantly lower in the GDA-R group (s < 0.05). CONCLUSIONS: This study identified improved intraoperative duodenal tissue oxygen saturation in the GDA-R group with an associated reduction in pancreatic leaks and CCI® morbidity risk. A larger prospective multicenter study comparing the two methods is warranted.


Subject(s)
Pancreas Transplantation , Humans , Pancreas Transplantation/methods , Prospective Studies , Duodenum/surgery , Pancreas/surgery , Pancreas/blood supply , Hepatic Artery
11.
Pancreatology ; 23(6): 697-703, 2023 Sep.
Article in English | MEDLINE | ID: mdl-37574438

ABSTRACT

OBJECTIVES: The dorsal pancreatic artery (DPA) is a pancreatic branch with various anatomical variations. Previous studies mostly focused on the origin of the DPA, and its pathways and branching patterns have rarely been examined. The purpose of this study was to investigate the branching patterns and pathways of the DPA. METHODS: This study included 110 patients who underwent computed tomography scans. We examined the pathways and branching patterns of the DPA. RESULTS: The DPA was identified in 101 patients (92%), and originated from the splenic artery in 30 patients (31%), the common hepatic artery in 17 patients (17%), the celiac trunk in 10 patients (10%), the superior mesenteric artery in 27 patients (27%), the replaced right hepatic artery in 7 patients (7%), the inferior pancreaticoduodenal artery in 5 patients (5%), and other arteries in 3 patients (3%). Four distinct types of branches were identified as follows: the superior branch (32%), the inferior branch (86%), the right branch (80%), and the accessory middle colic artery (12%). Additionally, the arcs of Buhler and Riolan were observed in two patients each and their anastomotic vessels followed almost the same pathway as the DPA. CONCLUSION: A number of variations of the DPA were observed with regard to its origin and branching pattern; however, the DPA and its branches always ran along the same pathway, as summarized in Fig. 4. The anatomical information gained from this study may contribute to performing safe pancreatic resections.


Subject(s)
Pancreas , Splenic Artery , Humans , Splenic Artery/diagnostic imaging , Splenic Artery/surgery , Pancreas/diagnostic imaging , Pancreas/surgery , Pancreas/blood supply , Mesenteric Artery, Superior/diagnostic imaging , Mesenteric Artery, Superior/anatomy & histology , Celiac Artery/diagnostic imaging , Celiac Artery/surgery , Embryonic Development
12.
Clin J Gastroenterol ; 16(6): 859-863, 2023 Dec.
Article in English | MEDLINE | ID: mdl-37608145

ABSTRACT

A 75-year-old female with a history of Parkinson's disease treatment and hypertension presented at the emergency section with sudden onset of right abdominal pain. Contrast-enhanced computed tomography revealed beaded irregular stenosis and dilation of the superior mesenteric artery (SMA) and an aneurysm in the branch of the pancreaticoduodenal artery (PDA) that communicates with the common hepatic artery and SMA. Additionally, a hematoma had formed in the retroperitoneal space, and extravasation of contrast medium from the pancreaticoduodenal artery aneurysm (PDAA) into the hematoma was observed. The celiac artery (CA) was compressed by the median arcuate ligament; stenosis of the CA at its origin and dilation on the distal side were observed. Based on the imaging findings, it was diagnosed that PDAA was ruptured, SMA developed segmental arterial mediolysis (SAM), and CA developed median arcuate ligament syndrome (MALS). The ruptured PDAA was thought to be caused by SAM combined with MALS. Transcatheter arterial embolization (TAE) was performed for the ruptured PDAA. To the best of our knowledge, there have been no reports of TAE for a ruptured PDAA caused by SAM and MALS. After TAE, the PDAA did not re-rupture.


Subject(s)
Aneurysm, Ruptured , Embolization, Therapeutic , Median Arcuate Ligament Syndrome , Female , Humans , Aged , Median Arcuate Ligament Syndrome/complications , Constriction, Pathologic/therapy , Pancreas/blood supply , Duodenum/blood supply , Aneurysm, Ruptured/complications , Aneurysm, Ruptured/diagnostic imaging , Aneurysm, Ruptured/therapy , Embolization, Therapeutic/methods , Celiac Artery/diagnostic imaging , Hematoma/complications
14.
Transplant Proc ; 55(4): 980-984, 2023 May.
Article in English | MEDLINE | ID: mdl-37137767

ABSTRACT

BACKGROUND: Due to the limited number of organ donations from deceased donors in Japan, pancreas grafts for pancreas transplantation (PTx) are frequently harvested from the donor in the same donation surgery as the liver graft. In such a situation, the common hepatic artery (CHA) and gastroduodenal artery (GDA) are dissected, resulting in decreased blood flow to the head of the pancreas graft. Therefore, GDA reconstruction using an interposition graft (I-graft) between the CHA and GDA has been traditionally performed to maintain blood flow. This study investigated the clinical significance of GDA reconstruction with the I-graft regarding the arterial patency of the pancreas graft in patients after PTx. METHODS: Fifty-seven patients underwent PTx for type 1 diabetes mellitus at our hospital between 2000 and 2021. Twenty-four cases in which GDA reconstruction was performed using the I-graft and artery blood flow of the pancreas graft was evaluated by contrast-enhanced computed tomography or angiography were included in this study. RESULTS: The patency of the I-graft was 95.8%, and only one patient had a thrombus in the I-graft. Nineteen patients (79.2%) had no thrombus in the artery of the pancreas graft; the other five cases had thrombus in the superior mesenteric artery (SMA). The patient with the thrombus in the I-graft required graftectomy for the pancreas graft. CONCLUSIONS: The patency of the I-graft was favorable. Furthermore, the clinical significance of the GDA reconstruction with the I-graft is suggested to maintain blood flow in the pancreas head if the SMA is occluded.


Subject(s)
Liver Transplantation , Pancreas Transplantation , Humans , Pancreas Transplantation/adverse effects , Pancreas Transplantation/methods , Hepatic Artery/surgery , Clinical Relevance , Pancreas/surgery , Pancreas/blood supply , Liver Transplantation/adverse effects , Liver Transplantation/methods
16.
Vasc Endovascular Surg ; 57(7): 768-770, 2023 Oct.
Article in English | MEDLINE | ID: mdl-36999613

ABSTRACT

Unlike other visceral artery aneurysms, pancreaticoduodenal artery aneurysms (PDAAs) should be treated regardless of their size. There are no reports on PDAA associated with celiac artery (CA) dissection. We, here, report the case of a patient with a ruptured PDAA with concomitant CA dissection. A 44-year-old Korean man presented to the emergency room of another hospital 29 days ago due to a sudden onset of abdominal pain. Contrast-enhanced abdominal computed tomography (CT) revealed a large right retroperitoneal hematoma and CA dissection. Subsequently, aortography revealed no specific bleeding focus. He underwent conservative treatment for 16 days, including a transfusion, and then was referred to us. His abdominal CT angiography revealed a diminishing retroperitoneal hematoma, a 7 mm × 8 mm PDAA at the anterior inferior pancreaticoduodenal artery aneurysm (PDA), and CA dissection. Selective celiac angiography revealed sluggish and diminished blood flow to the true lumen of the CA, and the hepatic, gastroduodenal, and splenic arteries were supplied by collaterals arising from the superior mesenteric artery (SMA). We performed elective coil embolization of the anterior PDA using the right femoral approach.We believe that postprocedural surveillance is required after CA dissection because of the potential risk of recurrent PDAA. Additionally, we suggest that hidden PDAA rupture should be considered for spontaneous retroperitoneal bleeding.


Subject(s)
Aneurysm, Ruptured , Embolization, Therapeutic , Male , Humans , Adult , Celiac Artery/diagnostic imaging , Pancreas/diagnostic imaging , Pancreas/blood supply , Embolization, Therapeutic/adverse effects , Treatment Outcome , Aneurysm, Ruptured/diagnostic imaging , Aneurysm, Ruptured/etiology , Aneurysm, Ruptured/therapy , Aortography
18.
Medicine (Baltimore) ; 102(5): e32834, 2023 Feb 03.
Article in English | MEDLINE | ID: mdl-36749241

ABSTRACT

RATIONALE: Visceral artery pseudoaneurysm is a rare complication of chronic pancreatitis (CP), all pancreatic or peripancreatic arteries have been reported to be involved, while hepatic artery is less common. PATIENT CONCERNS: This case report illustrated a 42-year-old man with CP who developed right hepatic artery pseudoaneurysm (HAP), and finally he was treated with intravascular embolization. DIAGNOSES: The patient suffered from HAP due to acute attack of CP. INTERVENTIONS: The pseudoaneurysm located in a fine branch of right hepatic artery was embolized. OUTCOMES: The HAP of the patient was cured. He had no recurrent bloody stool or abdominal pain. The symptoms gradually relieved. CONCLUSION: Herein, we report a patient with CP who developed right HAP causing infected hematoma, gastrointestinal bleeding, and obstructive jaundice, and a literature review is also presented. HAP caused by CP is a rare disease in the clinic, but rupture of pseudoaneurysm is fatal. Careful evaluation, early detection, and prompt treatment should be performed when the patient is admitted and followed up.


Subject(s)
Aneurysm, False , Pancreatitis, Chronic , Male , Humans , Adult , Aneurysm, False/etiology , Hepatic Artery , Pancreatitis, Chronic/complications , Pancreas/blood supply , Gastrointestinal Hemorrhage/etiology
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