Incidence and management of arterial injuries during pancreatectomy
Mushegh A. Sahakyan
Knut Jørgen Labori
Received: 19 December 2017 /Accepted: 12 March 2018 /Published online: 21 March 2018
Springer-Verlag GmbH Germany, part of Springer Nature 2018
Purpose The incidence of intraoperative arterial injury during pancreatectomy is not well described. This study aims to evaluate
the incidence, management, and outcome of arterial injuries during pancreatectomy.
Methods This is a retrospective study of 1535 consecutive patients undergoing pancreatectomy between 2006 and 2016 at Oslo
University Hospital. The type of arterial injury and potential contributing factors were analyzed. Short-term outcomes were
compared between patients with arterial injury and patients undergoing a planned arterial resection due to tumor involvement.
Results Arterial injury was diagnosed in 14 patients (incidence 0.91%), while planned arterial resection was performed in 22
patients. The injuries were located in the superior mesenteric artery (n = 5), right hepatic artery (n = 5), common hepatic artery
(n = 2), left hepatic artery (n = 1), and celiac trunk (n = 2). The artery was reconstructed in all except one patient. In 11 patients
with injury, peripancreatic inflammation, aberrant arterial anatomy, close relationship between tumor and injured artery, or a
combination of the three were found. Median estimated blood loss was 1100 ml in both groups. Rate of severe complications (≥
Clavien grade IIIa), comprehensive complication index, and 90-day mortality for patients with intraoperative arterial injury vs
planned arterial resection were 43 vs 45% (p = 0.879), median 35.9 vs 21.8 (p = 0.287), and 14.3 vs 4.5% (p = 0.551),
Conclusion Arterial injury during pancreatectomy is an infrequent and manageable complication. Early recognition and primary
repair in order to restore arterial liver perfusion may improve outcome. However, the morbidity is high and comparable to patients
undergoing a planned arterial resection.
Keywords Arterial resection during pancreatectomy
Arterial resection in patients undergoing pancreatectomy for
pancreatic cancer is associated with poor short- and long-term
outcomes and is not recommended on a routine basis [1, 2].
However, the use of multimodal therapy and increased expe-
rience in pancreatectomy with vascular resection has undoubt-
edly extended the boundaries in pancreatic surgery [3, 4].
Even though there are several reports from single-centers on
arterial resections, the current literature on the incidence and
management of arterial injuries during pancreatectomy is
scarce. The celiac trunk, superior mesenteric artery, hepatic
arteries, and their branches are important anatomical land-
marks in pancreatic surgery. Their close proximity to the bile
duct, portal vein, and pancreas make them susceptible to in-
jury. Moreover, the hepatic arterial system has been found to
display a variant anatomy in 55–79% of patients . Detailed
understanding of these variations has been appreciated for
over half a century [6, 7].
Postoperative liver failure is a rare, but potentially severe
complication associated with high mortality after pancreatic
surgery . Furthermore, ischemic complications due to
preexisting stenosis of the celiac trunk or the superior mesen-
teric artery, as well as intraoperative injury to the hepatic ar-
tery, are thought to be an underestimated cause of death after
Dyre Kleive and Mushegh A. Sahakyan contributed equally to this work.
* Dyre Kleive
Institute of Clinical Medicine, University of Oslo, Oslo, Norway
Department of Hepato-Pancreato-Biliary Surgery, Rikshospitalet,
Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway
Department of Surgery N1, Yerevan State Medical University after
M. Heratsi, Yerevan, Armenia
The Intervention Centre, Oslo University Hospital, Oslo, Norway
Department of Transplantation Medicine, Rikshospitalet, Oslo
University Hospital, Oslo, Norway
Langenbeck's Archives of Surgery (2018) 403:341–348