Surgeons must prioritize preoperative identification of celiac artery stenosis in patients undergoing pancreaticoduodenectomy to reduce ischemic complications.

• Celiac artery stenosis occurs in 6.1% of patients undergoing the procedure; only 2.2% had preemptive median arcuate ligament release.
• Stenosis over 80% significantly increases the risk of postoperative ischemia.

Identifying stenosis preoperatively results in fewer complications (5.8% vs. 36% for intraoperative/postoperative diagnoses).

• Utilize gastroduodenal artery clamping and intraoperative Doppler ultrasonography to guide management decisions effectively.