306 Endovascular Stenting Approaches Can Help Facilitate Safe Pancreaticoduodenectomy in Patients with Coeliac Artery or Superior Mesenteric Artery Stenosis: A Case Series Experience

Abstract Aim Coeliac artery (CA) or superior mesenteric artery (SMA) stenosis can preclude safe pancreaticoduodenectomy (PD) due to elimination of collateral blood supply mediated through the pancreaticoduodenal arcades. Optimisation of mesenteric blood flow is vital to reduce ischaemic complications. Treatment options include endovascular stenting and surgical approaches, such as median arcuate ligament release (MALR) or bypass. While intervention is practised in some pancreatic centres, there is yet to be a standardised approach within the United Kingdom. We describe our recent experience, spanning a 4-year period involving ten patients undergoing PD resection with CA or SMA intervention. Method Data was extracted from a prospectively kept department database, and an electronic patient record system was utilised to collect a detailed description of patient and disease factors, timing and technique of arterial stenting and standardised post-operative outcomes. Results Ten patients were identified as having a clinically significant CA or SMA stenosis. Three patients underwent MALR intra-operatively, three patients underwent CA stenting, and four patients underwent SMA stenting. Of these ten patients, two (20%) had a clinically relevant post-operative pancreatic fistula (cr-POPF). Adjusting for fistula risk scores, no significant difference was observed in POPF risk against actual POPF rate (p=0.927). One patient (10%) required re-operation for a gastro-jejunal anastomotic bleed, and two patients (20%) developed delayed gastric emptying (DGE). We experienced one mortality (10%) associated with prolonged DGE. Conclusions CA or SMA stenting can facilitate safe pancreaticoduodenectomy. Our patient cohort did not appear to be associated with an increased risk of POPF, or other routine complications experienced during PD.