Figure 1 - uploaded by Constantine N Antonopoulos
Content may be subject to copyright.
Arterial blood supply of the oesophagus. There are 3 levels of oesophageal extramural arterial supply, and it depends on the anatomic part of the oesophagus. The cervical oesophagus is supplied by final branches of the lower thyroid artery; branches from the descending thoracic aorta, the bronchial arteries and the right intercostal arteries are responsible for the arterial supply of the thoracic oesophagus, and the abdominal oesophagus is usually supplied by branches of the left gastric and left lower phrenic artery.
Source publication
Open in new tabDownload slide
Open in new tabDownload slide
There are few cases in the literature reporting dysphagia caused by oesophageal compression by the aorta due to acute or chronic aortic pathology. This type of dysphagia is called dysphagia aortica. Thoracic endovascular aortic repair is nowadays the treatment of choice for anatomically s...
Contexts in source publication
Context 1
... TEVAR. This compression can lead to oesophageal necrosis due to ischaemia [12] and subsequently to secondary aorto-oesophageal fistula (AOF) formation [1], which are rare but fatal complications following TEVAR [1,12]. There are 3 levels of oesophageal extramural arterial supply in humans, but it depends on the anatomic part of the oesophagus (Fig. 1). In detail, the cervical oesophagus arterial supply is provided by the final branches of the lower thyroid artery and by the rami oesophagei (Fig. 1). Branches directly from the descending thoracic aorta, the bronchial arteries and the right intercostal arteries are responsible for the arterial supply of the thoracic oesophagus (Fig. ...
Context 2
... [1], which are rare but fatal complications following TEVAR [1,12]. There are 3 levels of oesophageal extramural arterial supply in humans, but it depends on the anatomic part of the oesophagus (Fig. 1). In detail, the cervical oesophagus arterial supply is provided by the final branches of the lower thyroid artery and by the rami oesophagei (Fig. 1). Branches directly from the descending thoracic aorta, the bronchial arteries and the right intercostal arteries are responsible for the arterial supply of the thoracic oesophagus (Fig. 1). Finally, the left gastric and left lower phrenic artery give rise to the arterial bed of the abdominal oesophagus [15,17,24] (Fig. 1). ...
Context 3
... (Fig. 1). In detail, the cervical oesophagus arterial supply is provided by the final branches of the lower thyroid artery and by the rami oesophagei (Fig. 1). Branches directly from the descending thoracic aorta, the bronchial arteries and the right intercostal arteries are responsible for the arterial supply of the thoracic oesophagus (Fig. 1). Finally, the left gastric and left lower phrenic artery give rise to the arterial bed of the abdominal oesophagus [15,17,24] (Fig. 1). Occasionally, the oesophagus may also be supplied by branches of the aorta, the splenic artery, the coeliac trunk and an aberrant left hepatic artery [17] (Fig. 1). Apart from this multiple blood ...
Context 4
... by the rami oesophagei (Fig. 1). Branches directly from the descending thoracic aorta, the bronchial arteries and the right intercostal arteries are responsible for the arterial supply of the thoracic oesophagus (Fig. 1). Finally, the left gastric and left lower phrenic artery give rise to the arterial bed of the abdominal oesophagus [15,17,24] (Fig. 1). Occasionally, the oesophagus may also be supplied by branches of the aorta, the splenic artery, the coeliac trunk and an aberrant left hepatic artery [17] (Fig. 1). Apart from this multiple blood supply, a rich intramural oesophageal vascular network, which is able to support the whole oesophagus, is present [24]. The arterial blood ...
Context 5
... the arterial supply of the thoracic oesophagus (Fig. 1). Finally, the left gastric and left lower phrenic artery give rise to the arterial bed of the abdominal oesophagus [15,17,24] (Fig. 1). Occasionally, the oesophagus may also be supplied by branches of the aorta, the splenic artery, the coeliac trunk and an aberrant left hepatic artery [17] (Fig. 1). Apart from this multiple blood supply, a rich intramural oesophageal vascular network, which is able to support the whole oesophagus, is present [24]. The arterial blood supply of the oesophagus is shown in Fig. ...
Context 6
... may also be supplied by branches of the aorta, the splenic artery, the coeliac trunk and an aberrant left hepatic artery [17] (Fig. 1). Apart from this multiple blood supply, a rich intramural oesophageal vascular network, which is able to support the whole oesophagus, is present [24]. The arterial blood supply of the oesophagus is shown in Fig. ...
Context 7
... TEVAR. This compression can lead to oesophageal necrosis due to ischaemia [12] and subsequently to secondary aorto-oesophageal fistula (AOF) formation [1], which are rare but fatal complications following TEVAR [1,12]. There are 3 levels of oesophageal extramural arterial supply in humans, but it depends on the anatomic part of the oesophagus (Fig. 1). In detail, the cervical oesophagus arterial supply is provided by the final branches of the lower thyroid artery and by the rami oesophagei (Fig. 1). Branches directly from the descending thoracic aorta, the bronchial arteries and the right intercostal arteries are responsible for the arterial supply of the thoracic oesophagus (Fig. ...
Context 8
... [1], which are rare but fatal complications following TEVAR [1,12]. There are 3 levels of oesophageal extramural arterial supply in humans, but it depends on the anatomic part of the oesophagus (Fig. 1). In detail, the cervical oesophagus arterial supply is provided by the final branches of the lower thyroid artery and by the rami oesophagei (Fig. 1). Branches directly from the descending thoracic aorta, the bronchial arteries and the right intercostal arteries are responsible for the arterial supply of the thoracic oesophagus (Fig. 1). Finally, the left gastric and left lower phrenic artery give rise to the arterial bed of the abdominal oesophagus [15,17,24] (Fig. 1). ...
Context 9
... (Fig. 1). In detail, the cervical oesophagus arterial supply is provided by the final branches of the lower thyroid artery and by the rami oesophagei (Fig. 1). Branches directly from the descending thoracic aorta, the bronchial arteries and the right intercostal arteries are responsible for the arterial supply of the thoracic oesophagus (Fig. 1). Finally, the left gastric and left lower phrenic artery give rise to the arterial bed of the abdominal oesophagus [15,17,24] (Fig. 1). Occasionally, the oesophagus may also be supplied by branches of the aorta, the splenic artery, the coeliac trunk and an aberrant left hepatic artery [17] (Fig. 1). Apart from this multiple blood ...
Context 10
... by the rami oesophagei (Fig. 1). Branches directly from the descending thoracic aorta, the bronchial arteries and the right intercostal arteries are responsible for the arterial supply of the thoracic oesophagus (Fig. 1). Finally, the left gastric and left lower phrenic artery give rise to the arterial bed of the abdominal oesophagus [15,17,24] (Fig. 1). Occasionally, the oesophagus may also be supplied by branches of the aorta, the splenic artery, the coeliac trunk and an aberrant left hepatic artery [17] (Fig. 1). Apart from this multiple blood supply, a rich intramural oesophageal vascular network, which is able to support the whole oesophagus, is present [24]. The arterial blood ...
Context 11
... the arterial supply of the thoracic oesophagus (Fig. 1). Finally, the left gastric and left lower phrenic artery give rise to the arterial bed of the abdominal oesophagus [15,17,24] (Fig. 1). Occasionally, the oesophagus may also be supplied by branches of the aorta, the splenic artery, the coeliac trunk and an aberrant left hepatic artery [17] (Fig. 1). Apart from this multiple blood supply, a rich intramural oesophageal vascular network, which is able to support the whole oesophagus, is present [24]. The arterial blood supply of the oesophagus is shown in Fig. ...
Context 12
... may also be supplied by branches of the aorta, the splenic artery, the coeliac trunk and an aberrant left hepatic artery [17] (Fig. 1). Apart from this multiple blood supply, a rich intramural oesophageal vascular network, which is able to support the whole oesophagus, is present [24]. The arterial blood supply of the oesophagus is shown in Fig. ...
Similar publications
Aortic dissection is a complex pathology that carries significant morbidity and mortality if not treated in a timely fashion. While the open repair remains the gold standard treatment for patients with acute type A dissection, ascending aortic replacement is associated with high incidence of arch and descending thoracic aorta residual false lumen p...
Citations
... Therefore, once transmural necrosis occurs, the prognosis is really poor. According to a paper review only 2 of the 6 published cases with post-TEVAR esophageal necrosis survived [12]. The development of esophageal perforation indicates an infection leading to mediastinitis or sepsis. ...
... The average time of esophageal necrosis mentioned in publications is the 14th day after a TEVAR procedure, whereas the earliest onset was on the seventh post-TEVAR day [8][9][10][11]14]. Esophageal necrosis should be highly suspected in case of dysphagia within 1 month after a TEVAR procedure, after this period the most probable chronic condition is aorto-esophageal fistula [12]. Differential diagnosis between esophageal necrosis and AEF appears difficult. ...
Background
Esophageal necrosis and perforation after thoracic endovascular aortic repair (TEVAR) for ruptured traumatic aortic aneurysm is extremely rare. It is difficult to manage, and patients rarely survive without treatment. Although, there is no certain consensus in relation with the optimal treatment we present a subsequent successful management of both life-threatening conditions.
Case presentation
A 52-year-old man experienced a blunt chest trauma after motor vehicle collision with mild symptoms of pain and fractured ribs. On the 12th day he had severe chest pain and computed tomography (CT) revealed a ruptured traumatic thoracic aortic aneurysm with massive mediastinal hematoma. An emergency thoracic endovascular aortic repair (TEVAR) was performed. Several days later the patient developed a fever. CT suspected a pneumomediastinum, a sign of esophageal rupture, but no confirmation from esophagography and esophagoscopy was achieved. Because of deteriorated septic condition, patient was referred for exploratory thoracotomy. The rupture was found and esophagectomy was performed, with an esophagostomy and gastrostomy to enable enteral nutrition. Almost one year after the esophagectomy, gastric conduit reconstruction through the retrosternal route was performed. The patient was still alive and symptom-free more than 1 year after the reconstruction and no infection of the stent graft was observed.
Conclusion
We successfully managed a rare case of esophageal necrosis after TEVAR for ruptured traumatic thoracic aortic aneurysm. It is essential to diagnose the esophageal necrosis at an early stage and provide appropriate treatment to increase survival.
... Although the pharyngoesophageal region or upper esophageal sphincter can be affected by brainstem stroke or ACDF, the esophageal involvement of DA was more severe overall than those of DBI or DACDF [42,48,53]. The dysfunction of the nerves or vessels around the esophagus can be produced by esophageal compression [49,54]. ...
Dysphagia can be classified as oropharyngeal or esophageal, and functional or structural deficits of the esophagus can cause esophageal dysphagia. Dysphagia aortica (DA) is defined as dysphagia caused by extrinsic compression of the esophagus by the aorta. The aim of this study was to investigate the characteristics of DA by comparing the findings of videofluoroscopic swallowing studies (VFSS) with those of other dysphagia. Sixty-seven patients with postoperative dysphagia aortica (PDA), dysphagia after brainstem infarction (DBI), dysphagia after anterior cervical discectomy and fusion (DACDF), and subjective swallowing difficulty (SSD) without penetration and/or aspiration, who had undergone VFSS incorporating tests using 5 ml of thin and thick liquids, were included. The clinical data were collected retrospectively. The penetration-aspiration scale, functional dysphagia scale (FDS), esophageal transit time (ETT), and aortic lesion parameters (maximal diameter and distance between the lesion and the apex of the aortic arch) were assessed. The patients with PDA had higher FDS scores than the patients with SSD and lower scores than the patients with DBI did on thin liquids, while the FDS scores on thick liquids were lower in the patients with PDA than in those with DBI or DACDF. The patients with PDA had longer ETT than the other three groups. No correlation was found between the aortic lesion parameters and the VFSS findings. Although PDA has some oropharyngeal symptoms, the esophageal phase was affected mainly by PDA. After an operation on the aorta, VFSS should be considered before resuming oral feeding.
... DNM' den her iki cinsiyet de etkilenebilir, ancak erkeklerde 6:1 oranında daha sık görülmektedir. Akut mediastinit vakalarının çoğu hayatın üçüncü, dördüncü ve beşinci dekatlarında ortaya çıkar (5,6). ...
... Thus, Rieder (2010) reports a mortality rate of 11-34% for descending necrotising mediastinitis of oropharyngeal infections, but in case of associated comorbidities, this rate increases to 67% [4]. Both genders are reported to suffer from this disease, but males are more often affected, at a ratio of 6:1 [4,5]. Although the literature gives an account of exceptions, most cases of acute mediastinitis occur in the third, fourth, and fifth decades of life. ...
... Although the literature gives an account of exceptions, most cases of acute mediastinitis occur in the third, fourth, and fifth decades of life. The influence of age on the mortality rate has been substantiated with experimental data, with minor differences in the first two decades, but these differences become evident after the fifth decade of life [5]. Studies performed on large groups of patients report different but consistently high mortality rate (Table 1). ...
Background
Despite recent advancements in antibiotic therapy and the progress made in critical care and modern diagnostic methods, acute mediastinitis continues to be a severe condition.
Diagnosis and treatment
Acute mediastinitis can occur in the context of cardio-thoracic surgery, oesophageal perforations and oropharyngeal infections condition. Forty-five percent of oesophageal perforations occurs during simple endoscopy. Spontaneous perforation (Boerhaave syndrome) accounts for 15% of perforations, and twelve percent are due to the ingestion of foreign bodies. Other causes include blind or penetrating trauma, and circa 9% to intraoperative lesions. CT scan is the standard investigation that reveals direct signs of mediastinitis.
The oral administration of contrast substances can underscore the level of oesophageal perforation. Conservative treatment is the first-choice treatment and surgical treatment is reserved only for specific situations.
The principles of surgical treatment consist of drainage, primary suture, oesophageal exclusion with or without the application of oesophagectomy, endoscopic vacuum wound assisted therapy of the perforation and associated paraoesophageal mediastinal drainage and endoscopic stenting associated with drainage.
Conclusions
The lowest mortality rate is recorded in patients with perforations diagnosed less than twenty-four hours after the onset of symptoms. Surgical treatment remains the gold standard especially in cases of thoracic and abdominal perforations while further investigations are mandatory before endoscopic stenting is carried out.
This study aimed to modify a laser Doppler flowmeter designed and assembled at our institute. After measuring sensitivity evaluation in ex vivo experiments, we confirmed the efficacy of this new device for monitoring real-time esophageal mucosal blood flow changes after thoracic stent graft implantation by simulating various clinical situations in an animal model. Thoracic stent graft implantation was performed in a swine model (n = 8). Esophageal mucosal blood flow decreased significantly from baseline (34.1 ± 18.8 ml/min/100 g vs. 16.7 ± 6.6 ml/min/100 g, P < 0.05) in the lower esophagus (Th6-Th8) where the stent graft covered the aorta. In the hemorrhagic shock model (shock index ≥ 1.0), esophageal mucosal blood flow showed a remarkable change from baseline in the upper esophagus (Th1-Th3), where the stent graft did not cover the aorta (20.8 ± 9.8 ml/min/100 g vs. 12.9 ± 8.6 ml/min/100 g, P < 0.01); however, it returned to the baseline value within a 30-min period. Mucosal blood flow remained stable in the esophagus, where the stent graft did not cover the aorta. After elevating the mean blood pressure to > 70 mmHg with continuous intravenous noradrenaline infusion, esophageal mucosal blood flow increased significantly in both regions; however, the reaction was different between the two regions. Our newly developed laser Doppler flowmeter could measure real-time esophageal mucosal blood flow changes in various clinical situations during thoracic stent graft implantation in a swine model. Hence, this device can be applied in many medical fields by downsizing it.
