What is the blood supply to the esophagus?

Blood Supply of the Esophagus

The esophagus receives its blood supply primarily from the inferior thyroid artery for the cervical segment, branches of the descending thoracic aorta for the thoracic segment, and the left gastric artery for the abdominal segment. 1, 2, 3

Anatomical Distribution of Blood Supply

Cervical Esophagus

• Primary blood supply comes from the inferior thyroid artery 1
• In some cases, additional vessels originate directly from the subclavian artery
• These vessels approach the esophagus in a transverse direction
• The uppermost branches may supply both the posterior wall of the trachea and anterior wall of the esophagus, making surgical separation risky 1

Thoracic Esophagus

• Supplied by branches from the descending thoracic aorta (76.7% of esophageal arteries) 3
• Some branches (23.3%) originate from right intercostal arteries 3
• The inferior thoracic segment typically receives blood from a single artery with an average diameter of 1.42 ± 0.49 mm 2
• Most aortic branches (98.2%) originate between vertebral levels T6 and T11 3
• Intercostal-originated arteries (79.4%) typically arise from right intercostal arteries between T5 and T7 3

Abdominal Esophagus

• Primarily supplied by the left gastric artery 2
• Usually has two arterial supplies compared to the single artery supplying the thoracic segment
• Features semi-circular esophageal arteries with an average diameter of 2.06 ± 0.70 mm 2
• These semi-circular arteries give off 3-8 smaller branches that either:
  • Penetrate directly into the esophageal muscle of the abdominal segment
  • Anastomose with arterial branches from the inferior thoracic segment

Clinical Significance

Vascular Considerations in Esophageal Surgery

• The abdominal segment has a richer blood supply than the thoracic segment, which is important for lower esophageal sphincter function 2
• During esophageal surgery, particularly in the cervical region, care must be taken when separating the esophagus from the trachea due to shared blood supply 1
• The esophagus lacks a mesentery and "borrows" vessels from adjacent organs, making surgical mobilization challenging 4

Implications for Esophageal Perforation Management

• Understanding the blood supply is critical when managing esophageal perforations
• For cervical perforations, circumferential esophageal mobilization and repair with vascularized tissue buttressing is recommended 5
• For thoracic perforations, primary repair with debridement to healthy tissue and buttressing with viable tissue is essential 5
• For abdominal perforations, primary repair with Nissen fundoplication buttressing is recommended if approached transhiatally 5

Imaging Considerations

• Multidetector-row helical computed tomography can effectively visualize the esophageal arteries in approximately 90% of patients 3
• This imaging modality is valuable for preoperative planning, especially in esophageal cancer patients

The esophagus's unique blood supply pattern, spanning three body compartments without a dedicated mesentery, makes it particularly vulnerable during surgical procedures and explains why esophageal injuries can have significant morbidity and mortality if not properly managed.