Arterial supply for head of pancreas and its clinical significance

Objective To clarify the arterial supply and distribution and the anatomic characteristics of the head of pancreas,and provide definitive data of those arteries for the operation on pancreas and duodenum,as well as for arterial intubation and infusion therapy. Methods The head of pancreas from 24 adult cadavers and 4 children specimen were dissected and observed by 3 methods,including formalin fixation,arterial emulsion perfusion and artery casting with ABS (a copolymer of allyl cyanide,butadiene and styrolene). Another 22 patients were photographed by digital signature algorithmy (DSA). These obtained data were analyzed to recognize the arterial distribution of the head of pancreas and blood supply. Results The results obtained from 4 methods were as follow. The incidence of anterior superior pancreaticoduodenal artery was 100%,which were from the gastroduodenal artery and provided blood supply to the duodenum and the head of pancreas by branches. The incidence of posterior superior pancreaticoduodenal artery was 98%. The arteries derived from gastroduodenal artery occupied 96%,with the region of blood supply similar to that of the anterior superior pancreaticoduodenal artery supporting. The main characteristic was that they coiled with the common bile duct during the locomotion. The incidence of both anterior inferior pancreaticoduodenal artery and posterior inferior pancreaticoduodenal were 100% derived from arteria mesenterica superior and jejunal arteries with variation. They provided blood supply to inferior 1/3 part of the head of pancreas and jejunal arteries. Conclusion Posterior superior pancreaticoduodenal arteries play an essential role in blood supply for the pancreas and the duodenum. Moreover,they are paralleled with the common bile duct in a coiled coil way. Surgeons should pay more attention to this in clinical surgery. The anterior and posterior inferior pancreaticoduodenal artery should be ligated at the left border of uncinate process before its entrying into the head of pancreas,in order to avoid ligating the jejunal artery by mistaken.