Sequential Flow-Based Assessment of a Suspected Inferior Pancreaticoduodenal Artery-Derived Pathway Entering the Right Hepatic Artery during Pancreaticoduodenectomy: A Case Report

Introduction

During pancreaticoduodenectomy (PD), hepatic arterial ischemia is usually considered in patients with celiac artery stenosis or occlusion, in whom the gastroduodenal artery (GDA)-based pancreaticoduodenal arcade may serve as a critical collateral pathway. However, a similar but atypical pitfall may exist when the GDA and anterior superior pancreaticoduodenal artery (ASPDA) are absent: a prominent inferior pancreaticoduodenal artery (IPDA)-derived pathway may raise concern regarding hepatic inflow despite the anatomical presence of the common hepatic artery (CHA).