What is the minimum number of major vessels required for stomach survival?

From the Guidelines

The stomach can survive with just one major arterial supply due to its rich vascular network and extensive collateral circulation. The stomach naturally has a robust blood supply from multiple sources including the left gastric artery (from the celiac trunk), right gastric artery (from the hepatic artery), short gastric arteries (from the splenic artery), and the right and left gastroepiploic arteries. This redundant blood supply creates an extensive submucosal plexus that allows for significant vascular compromise without tissue necrosis, as seen in cases of chronic mesenteric artery disease where symptoms typically manifest when at least two mesenteric vessels are involved due to extensive collaterals 1. Some key points to consider include:

• The prevalence of asymptomatic coeliac artery and/or SMA stenosis is 3% in patients under 65 years of age and 18% in those aged >65, highlighting the importance of collateral circulation in maintaining stomach viability 1.
• Inadequate anastomoses can result in symptomatic ischaemia even with a single-vessel atherosclerotic occlusion, emphasizing the need for careful consideration of vascular supply in surgical procedures 1.
• During surgical procedures like gastrectomy or gastric mobilization, surgeons can ligate several of these vessels while maintaining stomach viability as long as at least one major arterial supply remains intact.
• This vascular redundancy is an evolutionary adaptation that provides protection against ischemia and explains why the stomach is often used successfully in reconstructive procedures where other vessels must be sacrificed.

From the Research

Minimum Vessels Required for Stomach Survival

The stomach requires a sufficient blood supply to function properly. According to the studies, the minimum number of major vessels required for stomach survival is not explicitly stated. However, the following points can be noted:

• The stomach is vascularized by four well-anastomosed main arteries: the right gastric artery, the left gastric artery, the right gastroepiploic artery, and the left gastroepiploic artery 2.
• Preservation of the right gastric and the right gastroepiploic vessels is a vital step to maintain an adequate perfusion of the gastric conduit 3.
• Compromise of these vessels, especially the right gastroepiploic artery, might result in ischemia or necrosis of the conduit 3.
• The actual number of vessels required for stomach survival may vary depending on the individual's anatomy and the presence of any underlying conditions.

Key Vessels Involved

Some key vessels involved in the blood supply of the stomach include:

• Right gastric artery
• Left gastric artery
• Right gastroepiploic artery
• Left gastroepiploic artery
• Gastroduodenal artery
• Short gastric arteries
• Posterior gastric artery (present in 36% of individuals) 2
• Accessory left gastric artery (present in 12% of individuals) 2

Consequences of Insufficient Blood Supply

Insufficient blood supply to the stomach can lead to:

• Ischemia or necrosis of the gastric conduit 3
• Gastric ischemia, which is a rare condition associated with poor prognosis 4
• Lethal nature of ischemic gastropathy, with a particularly poor prognosis if left untreated or diagnosed late 5