From the Guidelines
The blood supply of the conduit for esophageal replacement is primarily based on the right gastroepiploic artery and its branches for gastric conduits, as the left gastric, short gastric, and left gastroepiploic vessels are typically divided during mobilization 1.
Blood Supply to Different Conduits
- The gastric conduit, being the most commonly used, relies on the right gastroepiploic arterial arcade for its blood supply after the necessary divisions during surgery.
- For colonic conduits, the blood supply varies by segment: the left colon is supplied by the left colic artery, while the right colon is supplied by the middle colic artery.
- When the jejunum is utilized as a conduit, its blood supply comes from the jejunal branches of the superior mesenteric artery.
Importance of Blood Supply
Adequate blood supply to the conduit is crucial for preventing complications such as ischemia and anastomotic leakage, which can significantly impact morbidity, mortality, and quality of life in patients undergoing esophageal reconstruction 1.
Assessment of Conduit Viability
Techniques like Doppler ultrasonography or indocyanine green angiography are often employed intraoperatively to assess the viability of the conduit and ensure sufficient perfusion before proceeding with anastomosis, thereby minimizing the risk of post-operative complications 1.
From the Research
Blood Supply of the Conduit for Esophageal Replacement
The blood supply of the conduit for esophageal replacement can vary depending on the type of conduit used.
- For a gastric conduit, the blood supply is typically based on the right gastroepiploic artery, with minimal contribution from the right gastric artery 2.
- However, in some cases, the left gastroepiploic artery can be used as the sole supply artery for the gastric conduit, as seen in a case report where a reversed gastric conduit was used for esophageal reconstruction 3.
- For a jejunal conduit, the blood supply can be based on the third jejunal artery, which has been shown to provide adequate blood supply to the jejunum segment 4.
- In some cases, additional microvascular blood flow augmentation may be necessary to improve blood flow to the conduit, as seen in the "supercharge" technique used in esophageal and pharyngeal reconstruction 5.
- Sufficient blood supply to the conduit is mandatory for a successful esophageal reconstruction, and various techniques can be used to ensure adequate blood flow, including indocyanine green angiography and additional microvascular anastomosis 6.