ARTERIAL ANATOMIC CONSIDERATIONS IN COLON INTERPOSITION FOR ESOPHAGEAL REPLACEMENT

Background: Little has been written regarding the arterial anatomy pre dictive of success following esophagectomy and colon interposition. De sign: Retrospective review. Setting: University teaching hospital. Pat ients: Twenty-five patients undergoing planned left colon interpositio n. Intervention: Colon interposition was performed via an isoperistalt ic left colon graft based on the ascending branch of the left colic ar tey. 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 ar tery, (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 c olic artery. Venous drainage via a patent marginal vein, inferior mese nteric vein, and superior hemorrhoidal veins was preserved in all pati ents. Results: Left colon interposition could be performed in 21 (84%) of 25 patients. Eighty percent of the patients (20/25) had at least f our 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 p atent in all patients except one who required a right colon interposit ion. Ninety-two percent (23/25) demonstrated an adequate ascending lef t colic artery. The superior-inferior mesenteric artery anastomosis wa s seen in 52% (13/25). A single-trunked middle colic artery was presen t 80% (20/25) of the time. A single incidence of graft necrosis occurr ed secondary to venous insufficiency. Ninety-six percent of patients ( 24/25) were able to swallow without difficulty at the time of discharg e from the hospital. Conclusions: Replacement of the esophagus with co lon can be successful in over 80% of patients screened by angiographic criteria. Patients with an occluded or stenotic inferior mesenteric a rtery or variant middle colic arterial anatomy should undergo an alter nate reconstruction.