Impact of Celiac Artery Stenosis on Pancreatic Fistula Incidence after Pancreatoduodenectomy

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Abstract
Introduction: Celiac artery stenosis (CAS) may exacerbate postoperative complications by impairing arterial perfusion in upper abdominal organs. This study evaluated the prevalence of CAS in patients undergoing pancreaticoduodenectomy and its association with clinically significant postoperative pancreatic fistula (POPF). Methods: A retrospective analysis of 151 patients who underwent pancreaticoduodenectomy between 2017 and 2022 was conducted. CAS was assessed via preoperative computed tomography with a stenosis threshold of ≥50%. Multivariate logistic regression identified risk factors for POPF. Results: CAS ≥50% was observed in 17.2% of patients, and Grade B/C POPF occurred in 17.9%. In patients with a CAS ≥50%, the risk of POPF was significantly increased (Odds Ratio: 16.458, 95% Confidence Interval: 4.575–59.203, P < .001). A pancreatic duct diameter of less than 3 mm and a soft pancreatic texture were found to be associated with POPF in the univariate analysis ( P = .029, P = .032, respectively). Additionally, the prevalence of smoking and the median age were higher in patients with a CAS ≥50 (respectively, P = .011 and P = .052). Conclusions: CAS is an independent risk factor for clinically significant POPF. Preoperative CAS identification and management are vital to minimizing postoperative complications. Further studies are needed to confirm these findings.

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