PMC10421585_01
Sagittal reconstruction angiotomography of the abdominal aorta and its branches. The arrow indicates preoperative stenosis of the proximal portion of the celiac trunk and the post-stenotic dilatation.
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After the tomographic findings from the previous admission, the patient was scheduled for abdominal angiotomography the following month, which found stenosis of the celiac trunk (50%) (Figure 1).
Intraoperative image showing the celiac trunk after section of the fibers of the arcuate ligament. (A) Abdominal aorta; (B) Fibers of the arcuate ligament; (C) Left gastric artery; (D) Common hepatic artery with primary arteriorrhaphy; (E) Splenic artery with primary arteriorrhaphy.
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While releasing the celiac trunk, it was necessary to partially section the splenic and common hepatic arteries to gain access to the fibers of the arcuate ligament, since these vessels were intrinsically linked to the filaments, which caused moderate bleeding, that was controlled with primary arteriorrhaphy (Figure 2).
Sagittal reconstruction angiotomography of the abdominal aorta and its branches. The arrow indicates the improved celiac trunk stenosis after surgical intervention.
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The patient remained asymptomatic during the postoperative period and underwent a control angiotomography (Figure 3) 2 months after surgery, which showed improved celiac trunk stenosis at 60-70%, in addition to critical stenosis of almost 100% of the proximal segment of the splenic artery, with distal flow fed via collateral circulation originating from the gastroduodenal artery.