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Background <p>Identification of inferior pancreaticoduodenal artery (IPDA) on multi detector CT (MDCT) abdomen in relation to nearby vessels can guide its early ligation during pancreaticoduodenectomy (PD).</p> Methodology <p>Patients undergoing PD from March, 2022, to April, 2024, underwent 3D reconstruction of the vessels on MDCT and the distance between the root of the left renal vein (LRV), origin of superior mesenteric artery (SMA) and middle colic artery (MCA), and the origin of IPDA were estimated.</p> Results <p>Among 46 patients (standard PD and PD by early ligation of IPDA in 23 patients each) after exclusion, IPDA was identified intra-operatively within 1 cm and 5 mm of anticipated location as determined by 3D reconstructed MDCT from the root of LRV in 93.3% and 73.9% patients, from the origin of SMA in 96.7% and 80.4%, and from the origin of MCA in 100% and 95.6 % cases respectively The mean duration of surgery till PD specimen extraction (243.64 vs 299.71 min; p=0.0004), total duration of surgery (500.45 vs 551.62 min; p=0.002) and intraoperative blood loss (350[200-425] vs 405[300-500] ml; p=0.044) was significantly less in the ‘early ligation arm’ compared to the standard PD arm. Propensity matching of 23 patients in standard arm with historic controls without 3D reconstruction revealed similar duration of surgery (p=0.60) and blood loss (p=0.65).</p> Conclusion <p>3D vascular reconstruction of MDCT images accurately predicts identification of the origin of IPDA from above three vessels and facilitates its early ligation. Early ligation of IPDA can reduce blood loss and duration of surgery.</p>

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Three-Dimensional Vascular Reconstruction of the Peripancreatic Vessels on MDCT Images Facilitates Identification and Early Ligation of Inferior Pancreaticoduodenal Artery during Pancreaticoduodenectomy

  • 期刊论文

  • 发表日期：

    2026年5月4日

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  • Manoj Kumar Y L,
  • Nihar Mohapatra,
  • Piyush Kumar Sinha,
  • Shalini Thapar,
  • Nilesh Sadashiv Patil,
  • Shridhar Vasantrao Sasturkar,
  • Ragini Kilambi,
  • G Harsha Vardhan Reddy,
  • Viniyendra Pamecha

摘要

Background

Identification of inferior pancreaticoduodenal artery (IPDA) on multi detector CT (MDCT) abdomen in relation to nearby vessels can guide its early ligation during pancreaticoduodenectomy (PD).

Methodology

Patients undergoing PD from March, 2022, to April, 2024, underwent 3D reconstruction of the vessels on MDCT and the distance between the root of the left renal vein (LRV), origin of superior mesenteric artery (SMA) and middle colic artery (MCA), and the origin of IPDA were estimated.

Results

Among 46 patients (standard PD and PD by early ligation of IPDA in 23 patients each) after exclusion, IPDA was identified intra-operatively within 1 cm and 5 mm of anticipated location as determined by 3D reconstructed MDCT from the root of LRV in 93.3% and 73.9% patients, from the origin of SMA in 96.7% and 80.4%, and from the origin of MCA in 100% and 95.6 % cases respectively The mean duration of surgery till PD specimen extraction (243.64 vs 299.71 min; p=0.0004), total duration of surgery (500.45 vs 551.62 min; p=0.002) and intraoperative blood loss (350[200-425] vs 405[300-500] ml; p=0.044) was significantly less in the ‘early ligation arm’ compared to the standard PD arm. Propensity matching of 23 patients in standard arm with historic controls without 3D reconstruction revealed similar duration of surgery (p=0.60) and blood loss (p=0.65).

Conclusion

3D vascular reconstruction of MDCT images accurately predicts identification of the origin of IPDA from above three vessels and facilitates its early ligation. Early ligation of IPDA can reduce blood loss and duration of surgery.