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Upper Abdominal Surgery in Patients with Coeliac Artery Stenosis

Kyoji Ito, Nobuyuki Takemura, Ryo Oikawa, Fuyuki Inagaki, Fuminori Mihara, Norihiro Kokudo

Background and aim: Coeliac artery stenosis (CAS) is known as stenosis or obstruction of the coeliac artery (CA) due to various factors including median arcuate ligament (MAL) syndrome and atherosclerosis. Although CAS is often asymptomatic because of the formation of collateral blood flow, it occasionally causes ischemic complications after upper abdominal surgery. The aim of the present study was to overview reports on upper abdominal surgery in patients with CAS.

Methods: The articles on the clinical relevance of CAS and upper abdominal surgery were searched for in the PubMed database.

Results: Surgical procedures with relevance to CAS-related complications are pancreaticoduodenectomy, liver transplantation, oesophagectomy, and gastrectomy. Vascular clamping tests and Doppler ultrasonography are useful to evaluate the haemodynamics of CAS during surgery, although there were some reports with postoperative organ ischemia despite no signs of ischemic findings during surgery. The main strategies to resolve CAS are divided into four approaches: MAL division, preservation of the collateral artery, vascular reconstruction, and angioplasty by interventional radiology; although there were few reports comparing these approaches in upper abdominal surgery with CAS.

Conclusion: There was no established consensus on when an intervention is required for CAS in upper abdominal surgery. Therefore, careful assessment of arterial flow during and after surgery should be required to avoid CAS-related complications in upper abdominal surgery.