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Laparoscopic management of celiac artery compression syndrome

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Presentation on theme: "Laparoscopic management of celiac artery compression syndrome"— Presentation transcript:

1 Laparoscopic management of celiac artery compression syndrome
Glen S. Roseborough, MD, FRCS(C)  Journal of Vascular Surgery  Volume 50, Issue 1, Pages (July 2009) DOI: /j.jvs Copyright © 2009 Society for Vascular Surgery Terms and Conditions

2 Fig 1 A, Sagittal reconstruction of a computed tomography angiogram of a patient with celiac artery compression shows a widely patent celiac artery on inspiration. B, Sagittal reconstruction shows severe stenosis of the celiac artery on expiration. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

3 Fig 2 The abdominal port sites are shown for last patient treated in the series. Only one 12-mm port, which was for the fan retractor to retract the liver, and four 5-mm ports were used, thanks to improved resolution with 5-mm cameras. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

4 Fig 3 A celiac artery has been completely skeletonized and decompressed. AO, Aorta; HA, hepatic artery; LG, left gastric artery; MAL, median arcuate ligament; SA, splenic artery. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

5 Fig 4 A, In this lateral expiratory aortogram 2 months after celiac decompression in patient 15, stenosis is difficult to visualize despite being documented on mesenteric duplex ultrasound imaging and computed tomography angiography. B, Deployment of a stent in the same patient demonstrates high-grade intrinsic stenosis of the celiac artery. C, Completion angiogram after stenting. D, Follow-up angiogram shows stenosis at the origin of hepatic artery several months later, with recurrence of symptoms. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

6 Fig 5 Complications of celiac stents. A, A stent in a celiac artery placed before celiac decompression fractured only 1 month after deployment. B, Explanted stent from patient 14 with significant intimal hyperplasia. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

7 Fig 6 Lateral aortogram shows a patent celiac artery on (A) inspiration and (B) expiration. Selective angiogram of the superior mesenteric artery shows (C) good filling of distal branches of superior mesenteric artery on inspiration and (D) poor filling of distal branches on expiration, with shunting of blood flow into hepatic artery on expiration, a typical example of intramesenteric steal. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

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