0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
ARTICLE |

Arterial Anatomic Considerations in Colon Interposition for Esophageal Replacement

Jeffrey H. Peters, MD; Jeffrey W. Kronson, MD; Michael Katz, MD; Tom R. DeMeester, MD
Arch Surg. 1995;130(8):858-863. doi:10.1001/archsurg.1995.01430080060009.
Text Size: A A A
Published online

Background:  Little has been written regarding the arterial anatomy predictive of success following esophagectomy and colon interposition.

Design:  Retrospective review.

Setting:  University teaching hospital.

Patients:  Twenty-five patients undergoing planned left colon interposition.

Intervention:  Colon interposition was performed via an isoperistaltic left colon graft based on the ascending branch of the left colic artery.

Main Outcome Measures:  Five angiographic features were considered important to successful use of the left colon: (1) a patent inferior mesenteric artery, (2) a visible ascending branch of the left colic artery, (3) a well-defined anastomosis between the middle colic and left colic systems, (4) a single middle colic trunk prior to its division into right and left branches, and (5) a separate origin of the right colic artery. Venous drainage via a patent marginal vein, inferior mesenteric vein, and superior hemorrhoidal veins was preserved in all patients.

Results:  Left colon interposition could be performed in 21 (84%) of 25 patients. Eighty percent of the patients (20/25) had at least four of the five criteria thought necessary for optimal graft perfusion. Three or fewer criteria were present in five patients, three of whom underwent gastric interposition. The inferior mesenteric artery was patent in all patients except one who required a right colon interposition. Ninety-two percent (23/25) demonstrated an adequate ascending left colic artery. The superior-inferior mesenteric artery anastomosis was seen in 52% (13/25). A single-trunked middle colic artery was present 80% (20/25) of the time. A single incidence of graft necrosis occurred secondary to venous insufficiency. Ninety-six percent of patients (24/25) were able to swallow without difficulty at the time of discharge from the hospital.

Conclusions:  Replacement of the esophagus with colon can be successful in over 80% of patients screened by angiographic criteria. Patients with an occluded or stenotic inferior mesenteric artery or variant middle colic arterial anatomy should undergo an alternate reconstruction.(Arch Surg. 1995;130:858-863)

Topics

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Jobs
brightcove.createExperiences();