A selective strategy for celiac trunk non-reconstruction in visceral debranching hybrid surgery for abdominal aortic aneurysm

A selective strategy for celiac trunk non-reconstruction in visceral debranching hybrid surgery for abdominal aortic aneurysm | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report A selective strategy for celiac trunk non-reconstruction in visceral debranching hybrid surgery for abdominal aortic aneurysm Dongxue Geng, Yi Miao This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9285324/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Objective: To explore the feasibility and clinical value of a novel strategy involving selective nonreconstruction of the celiac trunk based on pancreaticoduodenal arterial arch collateralization during visceral zone debranching hybrid surgery for abdominal aortic aneurysms(AAA). Methods: We report the case of a patient with an abdominal aortic aneurysm involving the visceral arteries. Preoperative CTA demonstrated favourable pancreaticoduodenal arterial arch collateralization. An innovative strategy was adopted: only the superior mesenteric artery and bilateral renal arteries were revascularized, with selective nonreconstruction of the celiac trunk. The technical advantages of this strategy and the postoperative imaging validation results were analysed. Results: In this case, classic four-vessel revascularization was simplified to a three-vessel procedure, significantly reducing surgical difficulty and avoiding dissection posterior to the pancreas as well as pancreas-related complications. Postoperative CTA revealed satisfactory perfusion of the celiac trunk system, homogeneous enhancement of the liver parenchyma, robust retrograde filling of the pancreaticoduodenal arterial arch and gastroduodenal artery, absence of endoleak, and patency of the bypass grafts. Conclusion: Selective nonreconstruction of the celiac trunk via pancreaticoduodenal arterial arch collateralization represents an innovative strategy for visceral zone debranching in hybrid surgery for AAA. This strategy simplifies the procedure and reduces surgical trauma through a "subtraction" approach while ensuring adequate visceral perfusion. Postoperative CTA serves as a core tool for validating the efficacy of collateral compensation. Abdominal aortic aneurysm Hybrid surgery Visceral artery debranching Pancreaticoduodenal arterial arch Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 09 May, 2026 Reviews received at journal 04 May, 2026 Reviewers agreed at journal 30 Apr, 2026 Reviewers agreed at journal 30 Apr, 2026 Reviewers agreed at journal 28 Apr, 2026 Reviewers invited by journal 28 Apr, 2026 Editor invited by journal 07 Apr, 2026 Editor assigned by journal 04 Apr, 2026 Submission checks completed at journal 04 Apr, 2026 First submitted to journal 31 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9285324","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":631209297,"identity":"6ebc8241-031a-41fd-8df2-f01465db9f81","order_by":0,"name":"Dongxue Geng","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzUlEQVRIiWNgGAWjYBACfvb2AwcSfvy342dmPkCcFsmeM4kPPvYwJ0u2syUQp8XgRoKx4Qw2ZsYN53kMiHTZjYQ0aR4eNmbJZp6PN94w2MnpNhDQwdjz8Jg0jwUPHz8z72bLOQzJxmYHCGhhZgfbIgG0hXebNA/DgcRthLSwMSSYSfOwGTBuOMzzjDgtPBxg7yeAtLARp0WCBxzIB5Ilm9mMLecYEOEX++PgqDxgx89/+OGNNxV2cgS1oFlJbNQgaSFVxygYBaNgFIwIAABrMkBAGFd+sAAAAABJRU5ErkJggg==","orcid":"","institution":"Affiliated Hospital of Jiangsu University","correspondingAuthor":true,"prefix":"","firstName":"Dongxue","middleName":"","lastName":"Geng","suffix":""},{"id":631209298,"identity":"695a1c06-9359-4ab2-b1fc-400ce72c5992","order_by":1,"name":"Yi Miao","email":"","orcid":"","institution":"The Affiliated BenQ Hospital of Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yi","middleName":"","lastName":"Miao","suffix":""}],"badges":[],"createdAt":"2026-04-01 01:55:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9285324/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9285324/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108977875,"identity":"574b177f-f819-45eb-8922-40edfd499cc2","added_by":"auto","created_at":"2026-05-11 11:33:17","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":384038,"visible":true,"origin":"","legend":"","description":"","filename":"revisedartical.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9285324/v1_covered_ec8fe4ed-ac1c-411f-a339-f1e58b142969.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A selective strategy for celiac trunk non-reconstruction in visceral debranching hybrid surgery for abdominal aortic aneurysm","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Abdominal aortic aneurysm, Hybrid surgery, Visceral artery debranching, Pancreaticoduodenal arterial arch","lastPublishedDoi":"10.21203/rs.3.rs-9285324/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9285324/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eObjective: To explore the feasibility and clinical value of a novel strategy involving selective nonreconstruction of the celiac trunk based on pancreaticoduodenal arterial arch collateralization during visceral zone debranching hybrid surgery for abdominal aortic aneurysms(AAA). Methods: We report the case of a patient with an abdominal aortic aneurysm involving the visceral arteries. Preoperative CTA demonstrated favourable pancreaticoduodenal arterial arch collateralization. An innovative strategy was adopted: only the superior mesenteric artery and bilateral renal arteries were revascularized, with selective nonreconstruction of the celiac trunk. The technical advantages of this strategy and the postoperative imaging validation results were analysed.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResults: In this case, classic four-vessel revascularization was simplified to a three-vessel procedure, significantly reducing surgical difficulty and avoiding dissection posterior to the pancreas as well as pancreas-related complications. Postoperative CTA revealed satisfactory perfusion of the celiac trunk system, homogeneous enhancement of the liver parenchyma, robust retrograde filling of the pancreaticoduodenal arterial arch and gastroduodenal artery, absence of endoleak, and patency of the bypass grafts.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConclusion: Selective nonreconstruction of the celiac trunk via pancreaticoduodenal arterial arch collateralization represents an innovative strategy for visceral zone debranching in hybrid surgery for AAA. This strategy simplifies the procedure and reduces surgical trauma through a \"subtraction\" approach while ensuring adequate visceral perfusion. Postoperative CTA serves as a core tool for validating the efficacy of collateral compensation.\u003c/p\u003e","manuscriptTitle":"A selective strategy for celiac trunk non-reconstruction in visceral debranching hybrid surgery for abdominal aortic aneurysm","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-11 09:52:57","doi":"10.21203/rs.3.rs-9285324/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-09T07:44:20+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-04T14:04:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"80850384930490209520445786937874854087","date":"2026-04-30T23:32:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"179321814595923407533215439048006815513","date":"2026-04-30T12:30:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"164928071543408102753462267059724368521","date":"2026-04-28T15:41:56+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-28T10:22:23+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-07T10:18:24+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-04T09:57:30+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-04T09:57:10+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Surgery","date":"2026-04-01T01:43:31+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f758d0ea-4c53-4dd8-9335-4a66afcdfeb7","owner":[],"postedDate":"May 11th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-09T07:44:20+00:00","index":58,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-04T14:04:50+00:00","index":40,"fulltext":""},{"type":"reviewerAgreed","content":"80850384930490209520445786937874854087","date":"2026-04-30T23:32:56+00:00","index":39,"fulltext":""},{"type":"reviewerAgreed","content":"179321814595923407533215439048006815513","date":"2026-04-30T12:30:20+00:00","index":38,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-11T09:52:57+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-11 09:52:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9285324","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9285324","identity":"rs-9285324","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}