Impact of variant pancreatic arterial  anatomy and overlap in regional perfusion on the interpretation of selective arterial XXXX stimulation with hepatic venous sampling for preoperative localization of @entity9608 .

@entity9608 @entity1 @entity6029 @entity460
BACKGROUND: To determine the impact of variant pancreatic arterial anatomy and overlap in regional perfusion on the interpretation of selective arterial @entity460 stimulation (SACST) with hepatic venous sampling for preoperative localization of @entity9608 . METHODS: An institutional review board-approved retrospective review was undertaken of 42 @entity1 with surgically confirmed, @entity9608 who underwent SACST from January 1996 to March 2014. @entity9608 was predicted initially based on the biochemical results of SACST alone according to Doppman's criteria. Pancreatic arteriograms were reviewed blinded to the biochemical results and the regional perfusion of each artery assessed. The anatomic and perfusion data were combined with the biochemical results to make a second prediction and compared with the surgical findings. RESULTS: The biochemical results were positive in 1, 2, and 3 arterial distributions in 73.8%, 21.4%, and 4.8% of @entity1 , respectively. The celiac trunk and @entity6029 ( @entity6029 ) anatomy were aberrant in 38.1% and 35.7% of @entity1 , respectively. Clinically significant variations included dorsal pancreatic artery replaced to @entity6029 (21.4%) and celiac stenosis (4.8%). Significant variation and overlap in regional pancreatic perfusion was observed, particularly for the @entity6029 . Sensitivity for insulinoma localization was 54.8% (diagnostic arteriography), 73.8% (biochemical data), 88.1% (biochemical, anatomic, perfusion data), and 92.8% (arteriographic, biochemical, anatomic, perfusion data). CONCLUSION: Careful review of the pancreatic arterial anatomy and regional perfusion is critical for correct interpretation of the biochemical results of SACST and improves the sensitivity of localization for @entity9608 , particularly in the presence of pancreatic arterial variants or overlap in regional perfusion.
