Article

Pancreatic angiography

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Abstract

Angiography has become an important procedure in the diagnosis of pancreatic disease. Because of the difficulty in examining the pancreas by the traditional roentgenographic techniques such as gastrointestinal barium examinations, hypotonic duodenography, and endoscopic retrograde pancreatography (ERCP), angiography serves as a complementary study. Perhaps the chief attribute is its role in diagnosing pancreatic tumors. The angiogram can aid in showing the extent of a tumor, its resectability, and vascular variations which may complicate the surgical procedure. It is the procedure of choice for diagnosing and locating islet cell adenomas because they frequently are small and difficult to find on exploration. With accurate localization, only limited resection of the pancreas is needed and operative mortality and morbidity are reduced.1 Pancreatitis is more of a clinical diagnosis than an angiographic one. However, it must be differentiated from pancreatic carcinoma. Angiography is also an aid in the diagnosis of cystadenomas and cystadeno-carcinomas, other rare endocrine tumors, metastatic disease, and lymphomas. Occasionally, it is an aid in the diagnosis of trauma and congenital vascular abnormalities.

Technique

Since the first selective celiac and superior mesenteric angiograms performed by arteriotomy of the carotid or brachial arteries in 1951,2 angiographic technique has been perfected to almost a fine art. Today, pancreatic angiography is usually performed by a percutaneous femoral approach utilizing the Seldinger technique, first performed in 1953.3 If the femoral arteries cannot be utilized secondary to severe atherosclerotic disease, axillary catheterization is a good alternative.4,5 Usually celiac and superior mesenteric angiography should be performed either as . .


 

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