Duodenal branches of posterior superior pancreaticoduodenal artery

The duodenal branches of the posterior superior pancreaticoduodenal artery (PSPDA) are small arterial rami that arise from the PSPDA as it courses along the posterior aspect of the pancreatic head, and they supply the duodenal wall particularly the first (D1) and second (D2) portions of the duodenum as well as the region of the major duodenal papilla (papilla of Vater) and the common bile duct.

Surgical Significance

These branches are not completely buried within the pancreatic parenchyma and can be dissected from the pancreas.

Preservation of the duodenal branches of the PSPDA is essential during duodenum-preserving resection of the pancreatic head (Beger procedure), as these branches represent the primary arterial supply to the duodenal wall and papilla in this region. Kimura and Nagai demonstrated in 40 autopsy cases that the pancreaticoduodenal arteries and their duodenal branches were never completely embedded in the pancreatic parenchyma, making it feasible to dissect the pancreas from the duodenum while preserving these vessels though dissection near the accessory papilla was notably more difficult. Additionally, the close relationship of the PSPDA to the common bile duct at the posterior surface of D1 poses a risk of bile duct injury during hemostasis of bleeding duodenal ulcers.