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Anatomy of the Pharynx and Oesophagus
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
The cervical oesophagus gets its main blood supply superiorly from the inferior thyroid artery of the thyrocervical trunk. The thoracic section of the oesophagus gains some of its blood supply segmentally from branches of the descending aorta or by branches of the bronchial and oesophageal arteries. Approximately five oesophageal arteries arise from the aorta anteriorly and these descend to supply the oesophagus by forming a vascular chain on the oesophagus itself. The vascular chain anastomoses with the branches of the inferior thyroid artery above as well as with the branches of the left phrenic and left gastric arteries below. The abdominal oesophagus is thus supplied by the left gastric and left inferior phrenic arteries. A dense blood supply and the anastomotic nature of the oesophageal blood supplying it render the organ virtually immune to infarction.
The thyroid gland
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
The normal thyroid gland weighs 20–25 g. The functioning unit is the lobule supplied by a single arteriole and consists of 24–40 follicles lined with cuboidal epithelium. The follicle contains colloid in which thyroglobulin is stored (Figure50.2). The arterial supply is rich, and extensive anastomoses occur between the main thyroid arteries and branches of the tracheal and oesophageal arteries (Figure50.3). There is an extensive lymphatic network within and around the gland. Although some lymph channels pass directly to the deep cervical nodes, the subcapsular plexus drains principally to the central compartment juxtathyroid – ‘Delphian’ and paratracheal nodes and nodes on the superior and inferior thyroid veins (level VI), and from there to the deep cervical (levels II, III, IV and V) and mediastinal groups of nodes (level VII) (Figure50.4).
Complications of Esophageal Surgery and Trauma
Published in Stephen M. Cohn, Matthew O. Dolich, Complications in Surgery and Trauma, 2014
Peter P. Lopez, Joseph R. Buck, Lawrence N. Diebel
The arterial blood supply of the esophagus is derived from the inferior thyroid artery (neck), the segmental esophageal arteries branching off the aorta (thorax), and the left gastric and splenic artery (abdomen). These arteries branch into small vessels some distance from the esophagus before penetrating the esophageal muscle layers. This branching allows blunt mobilization of the esophagus during a transhiatal esophagectomy because these small vessels contract to assist in hemostasis. Upon entering the esophagus, these arteries branch at right angles, thereby establishing a longitudinal anastomosing network of vessels. This early branching and collaterization between the cervical, thoracic, and gastric segments desegmentalizes the esophageal blood supply. Thus, the entire esophagus can be mobilized with a blood supply based on the inferior thyroidal artery. Poor technique rather than poor blood supply is the usual reason for anastomotic failure [1]. However, the surgeon must exercise caution if the inferior thyroid arteries have been compromised by prior partial or complete thyroidectomy or by any other previous surgical procedure or radiotherapy.
Acute necrotizing esophagitis presenting with severe lactic acidosis and shock
Published in Baylor University Medical Center Proceedings, 2018
Kenneth Iwuji, Sarah Jaroudi, Arpana Bansal, Ana Marcella Rivas
Although the etiology of acute esophageal necrosis is hypothesized to be multifactorial, vascular compromise seems to be a mainstay.2 The “two-hit” hypothesis describes an initial low flow state due to a vasculopathy or hemodynamic instability that leaves the esophageal mucosal barriers susceptible to gastric acid reflux insults in the setting of gastric outlet obstruction. The esophagus has an intricate vascular supply that is rarely susceptible to ischemia but in the case of the two-hit hypothesis can reveal transient necrosis that will rapidly recover with restoration of flow. The blood supply is distributed among segments of the esophagus, with the distal segment known as a “watershed” area where acute esophageal necrosis tends to be detected. The upper esophagus is supplied by the descending branches of the inferior thyroid arteries. The middle esophagus receives its blood supply from branches off the descending aorta that include the bronchial arteries, right third or fourth intercostal arteries, and esophageal arteries. Lastly, the distal esophagus derives its supply from the branches off the left gastric artery or left inferior phrenic artery. In addition, numerous contributions are derived from surrounding arteries leading to a rich vascular supply.2 This rich arterial connection makes ischemic esophagus necrosis a rare finding.
Laser balloon in pulmonary vein isolation for atrial fibrillation: current status and future prospects
Published in Expert Review of Medical Devices, 2021
Shota Tohoku, Stefano Bordignon, Fabrizio Bologna, Shaojie Chen, Lukas Urbanek, Felix Operhalski, KR Julian Chun, Boris Schmidt
A histologic study described that the distance between the esophagus and LA posterior wall is shorter than 5 mm in 40% of specimens, and therefore, the esophageal arteries and the vagal nerve plexus on the anterior surface of the esophagus may be affected by ablation procedures [42].