Pancreaticoduodenal Arteries

arteriae pancreaticoduodenales

The pancreatic head and duodenum are supplied by anterior and posterior pancreaticoduodenal arcades: the superior pancreaticoduodenal artery (from the gastroduodenal artery / celiac axis) has anterior and posterior branches; the inferior pancreaticoduodenal artery (from the SMA) also has anterior and posterior branches. The anterior and posterior arcades form anastomotic loops around the duodenum and pancreatic head, providing a rich collateral supply. This dual supply (celiac + SMA) is why pancreaticoduodenal artery aneurysms form when one source is stenosed.

Region: Abdomen

Clinical Relevance

Clinical Notes

The pancreaticoduodenal arcade is the critical anatomy for pancreaticoduodenectomy (Whipple procedure): the gastroduodenal artery (GDA) is ligated at its hepatic artery origin, and the superior pancreaticoduodenal branches are divided as the specimen is separated from the hepatic artery. The inferior pancreaticoduodenal artery from the SMA must be identified and preserved or ligated at the appropriate level during the uncinate process dissection. Pancreaticoduodenal artery aneurysms form as collateral vessels in celiac axis stenosis from median arcuate ligament compression, the classic arcade aneurysm of MALS.

Pathology

Common Injuries & Conditions

Pancreaticoduodenal Arcade Aneurysm in Celiac Axis Stenosis

Celiac axis compression by the median arcuate ligament produces increased flow through the pancreaticoduodenal arcade as SMA-to-celiac collateral, leading to aneurysm formation in the arcade vessels; rupture presents with retroperitoneal haemorrhage and is treated by embolisation and median arcuate ligament release.