Anatomical basis for pancreas transplantation via isolated splenic artery perfusion: A literature review

Abstract

The variability of vascular anatomy of the pancreas underlines the difficulty of its transplantation. Research regarding the consistency of anatomical variations shows splenic arterial dominance in most cases. This can significantly improve transplantation success. A systematic literature review was performed according to the quality standards described in the AMSTAR measurement tool and the PRISMA guidelines. We valuated existing literature regarding the vascularization and blood perfusion patterns of the pancreas in terms of dominance and variability. The collected data was independently analyzed by two researchers. Variance of vascular anatomy was seen to be underreported in literature, though significant findings have been included and discussed in this study, providing valuable insight into the dynamics of pancreatic perfusion and feasibility of transplantation on several different supplying arteries. The splenic artery (SA) has a high percentage of consistency in all found studies (over 90%). High frequency of anastomoses between arterial pools supplying the pancreas can mediate sufficient blood supply through a dominant vessel, such as the SA, which is present in most cases. Pancreatic transplantation with isolated SA blood supply can provide sufficient arterial perfusion of the pancreas for stable transplant viability due to high anatomical consistency of the SA and vast communications with other arterial systems.

Keywords: Pancreas transplantation; Isolated splenic artery supply; Pancreas anatomy; pancreatic perfusion; Minireview

Core Tip: We summarize existing findings on the variant anatomy of pancreatic blood supply to justify, from an anatomical point of view, the possibility of pancreatic transplantation with isolated splenic artery blood supply (ISABS). The blood supply of the pancreas is characterized the absence of a single large source arterial inflow, and an intimate communication with arteries of the surrounding organs. The practical significance of anatomical features of blood supply of cephalocervical and corporocaudal segments of the pancreas and well-described numerous arterial collaterals and anastomoses of these areas are the basis for establishing collateral circulation in cases of reduced blood flow through one or more arteries or in case of pancreatic transplantation with ISABS.