Pancreatic artery

In splenic trauma, with a life-long increased risk of sepsis after splenectomy, non-operative treatment is the management of choice. In several studies the efficacy of TAE has been shown to be over 90% (Hagiwara et al. 1996). Embolization of the splenic artery, distal to the pancreatic artery, leads to splenic preservation resulting from collateriza-tion by pancreatic and gastric branches. 

The pancreatoduodenal arcade provides an extensive collateral vascular network to the head of the pancreas, uncinate process, and duodenal bulb with a complex anatomical disposition and anastomotic channels with named arteries such as the dorsal pancreatic artery, the supraduodenal artery, and the retroduodenal artery [8-13]. 

The dorsal pancreatic artery is the first major pancreatic branch, usually coming off the splenic artery, although many variations have been described (right hepatic artery, SMA, and celiac artery) [15]. After supplying the dorsal surface of the neck of the pancreas, it divides into a left branch, the transverse pancreatic, and into a right branch (branches), which unites with the gastroduodenal or the superior pancreatoduodenal [14]. 

The transverse pancreatic artery is one of the major arteries of the pancreas and generally the major left branch of the dorsal pancreatic. It courses along the inferior surface of the pancreas to unite with the a. pancreatica magna (branch of the splenic artery) [14]. 

Bertelli E, Di Gregorio F, Mosca S, Bastianini A (1998) The arterial blood supply of the pancreas a review. V. The dorsal pancreatic artery. An anatomic review and a radiologic study. Surg Radiol Anat 20 445-452... 

The duodenum is supplied by the pancreaticoduodenal arteries, consisting of two, sometimes three or more trunks bridging the gastroduodenal and superior mesenteric artery. One pancreaticoduodenal arcade is located anteriorly (mostly as a continuation of the gastroduodenal artery) and one posteriorly, with multiple anastomoses between them and other pancreatic arteries, building a rich collateral plexus (Fig. 5.4). 

Capek P, Rocco M, McGahan J et al (1992) Direct aneurysm puncture and coil occlusion a new approach to pari-pancreatic arterial pseudoaneurysms. JVIR 3 653-656... 

Hong KC, Ereeny PC (1999) Pancreatioduodenal arcades and dorsal pancreatic artery comparison of CT angiography with three-dimensional volume rendering, maximum intensity projection and shaded-surface display. AJR AM J Roentgenol 211 337-343... 

Proximal Embolization In the absence of active contrast extravasation, the splenic artery is proximally embolized. We typically utilize either a 5F Cobra catheter or a 5F Omni-2 catheter to catheterize the celiac axis. Depending on the tortuosity of the vessel, we then either use the Cobra catheter or a microcatheter with a 0.021 inner luminal diameter for more selective catheterization. Once the catheter is in place, just distal to the dorsal pancreatic artery, coils are deposited. The size of the coils chosen depends on the size of the vessel. 

Acute pancreatitis has been induced in dogs by retrograde intraductal injections of 5% hydrogen peroxide solution and sunflower oil (Keleman and Torok, 1990) and in rats by continuous infusion of xanthine/XO or hydrogen peroxide into the coeliac artery (Tamura et al., 1991a). Xanthine/XO has also been shown to be toxic, as measured by release of LDH, to in vitro rat pancreatic acini (Tamura et al., 1991b). 

Superior mesenteric artery syndrome Enteric infections Inflammatory bowel diseases Pancreatitis Appendicitis Cholecystitis Biliary colic Gastroparesis Postvagotomy syndrome Intestinal pseudo-obstruction Functional dyspepsia Gastroesophageal reflux Peptic ulcer disease Hepatitis Peritonitis Gastric malignancy Liver failure... 

Laboratory values Tlactate, 4-arterial pH, iserum bicarbonate, TAST/ALT, TPT, TT.bili, Tamylase/lipase (with pancreatitis)... 

The endogenous release of the potent vasoconstrictor neuropeptide Y (NPY) is increased during sepsis and the highest levels are detected in patients with shock (A8). NPY is a 36-amino-acid peptide belonging to the pancreatic polypeptide family of neuroendocrine peptides (T2). It is one of the most abundant peptides present in the brain and is widely expressed by neurons in the central and peripheral nervous systems as well as the adrenal medulla (A3). NPY coexists with norepinephrine in peripheral sympathetic nerves and is released together with norepinephrine (LI9, W14). NPY causes direct vasoconstriction of cerebral, coronary, and mesenteric arteries and also potentiates norepinephrine-induced vasoconstriction in these arterial beds (T8). It appears that vasoconstriction caused by NPY does not counterbalance the vasodilatator effects of substance P in patients with sepsis. The properties of vasodilatation and smooth muscle contraction of substance P are well known (14), but because of the morphological distribution and the neuroendocrine effects a possible stress hormone function for substance P was also advocated (J7). Substance P, which is a potent vasodilatator agent and has an innervation pathway similar to that of NPY, shows a low plasma concentration in septic patients with and without shock (A8). 

Gallbladder disease, hepatic adenoma, pancreatitis, thrombosis of abdominal artery or vein Endometrial, cervical, or vaginal cancer Deep vein thrombosis... 

Administration by experienced physician only pts should be hospitalized for 1st course d/t risk for severe Rxn Uses G1 adenoma, liver, renal cancers colon pancreatic CAs Action Converted to 5-FU inhibits thymidylate synthase DNA synth (S-phase specific) Dose 0.1-0.6 mg/kg/d for 1-6 wk (per protocols) usually intra-arterial for liver mets Caution [D, -] Interaction w/ vaccines Contra BM... 

A 55-year-old woman with a history of chronic pancreatitis developed epigastric pain and melena and was found to have a splenic artery pseudoaneurysm expanding a pseudocyst. She was given an intravenous bolus of octreotide followed by an infusion of 50 micrograms/ hour. A CT scan subsequently suggested thrombosis of the pseudoaneurysm, with segmental splenic infarction. Nine months later the pseudoaneurysm had recanalized. 

Tang LJ, Zipser S, Kang YS. Temporary spontaneous thrombosis of a splenic artery pseudoaneurysm in chronic pancreatitis during intravenous octreotide administration. J Vase Interv Radiol 2005 16(6) 863-6. 

De Rone T, VanBeers B, de Canniere L, Trigaux JP, Melange M. Thrombosis of splenic artery pseudoaneurysm complicating pancreatitis Gut 1993 34 1271-3. 

Beta adrenergic receptor antagonists reduce cardiac output (caused by negative chronotropic and inotropic effects), decrease renin release from the kidneys, and cause smooth muscle relaxation. However, blockage may also decrease secretion of insulin from pancreatic P-cells, which limits its use in T2D. Calcium channel antagonists act on L-type voltage gated channels in the heart and blood vessels to reduce vascular resistance and arterial pressure. Diuretics are also widely used to decrease blood pressure, particularly in the elderly and hypertensive black populations. 

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