Variations In Blood Supply Research Articles

Accessory renal artery supplying suprarenal gland and gonad - its clinical importance and embryological basis

Renal transplantation is quiet impressive number as it is a treatment of choice for chronic kidney diseases so knowledge of variations in blood supply of kidney, suprarenal gland and gonad during surgical intervention, renal vascular imaging and understanding of medical problem related with kidney diseases. During routine cadaveric study we came across with multiple variations in blood supply to the kidney, suprarenal gland and gonad in a 65 years old male formaldehyde fixed embalmed body. The right kidney was supplied by an accessory renal artery along with main renal artery. Accessory renal artery, which was also supplying supra renal gland and gonad through inferior suprarenal and gonadal artery respectively. Variant blood supply to suprarenal gland, kidney and gonad is important during surgery, interventional radiography and anatomical point of view because it can affect the orientation of the surgeon during laparoscopic adrenalectomy, kidney transplantation, renal vascular imaging to prevent unwanted complications.

VARIATION IN ORIGIN OF SUPERIOR THYROID ARTERY AND ITS CLINICAL RELEVANCE: A CASE REPORT

Thyroid surgeries are most common neck surgeries; hence thorough knowledge of the variations in blood supply of this gland to the surgeons is very important to prevent any alarming hemorrhage or iatrogenic damage. We found a variation in origin of superior thyroid artery on right side during routine dissection on an adult male cadaver in the Department of Anatomy, A.I.I.M.S, NewDelhi. Left superior thyroid artery was normal. Right side, superior thyroid artery was arising from common carotid artery instead of external carotid artery, just proximal to the bifurcation of common carotid artery. This variant branching pattern of superior thyroid artery is very rare. The inferior thyroid arteries did not show any unusual origin. Knowledge of such arterial variations related to the thyroid gland is immensely helpful to the surgeons to avoid damage of the vital organs in this region.

What is the Best Choice for Esophageal Replacement in Children?

Esophageal replacement surgery is performed in children with either congenital long gap esophageal atresia or acquired esophageal damages such as caustic injury of the esophagus. although the left colon because of less variation in blood supply and suitable diameter in comparison with right colon is the better choice. A secured pedicled colon is mandatory for reducing the sever complications, such as leak and necrosis. Ileocolic conduit is an alternative method of colon interposition which has anti reflux effect and therefore with less complications related to gastroesophageal reflux. When we have a short segment esophageal stricture due to corrosive esophagitis or other causes of esophageal strictures which is refractory to repeated dilatations, it is advisable to perform colon patch esophagoplasty. Gastric transposition can produce a good way for gastrointestinal continuity with a perfect weight gain and oral feeding, therefor it can be a safe choice for esophageal replacement in children. Partial gastric pull-up is an alternative operation for esophageal replacement in children and infants with long gap esophageal atresia. Gastric conduit replacement is another alternative technique for esophageal replacement, in which a gastric tube is created in the abdomen and it is pulled to via thoracic cavity to the neck and is committed by cervical anastomosis. Antral patch esophagoplasty is used for benign and limited esophageal stricture due to gastroesophageal reflux. Usefulness of pedicled jejunum was under optimal results because of technical problems and high rate of necrosis and mortality for decades. Sternocleidomastoid myocutaneous esophagoplasty is a scarce method which is reported by some surgeons for limited cervical esophageal stricture repair. Free microvascular transfer of the reverse ileo-colon flap with ileocaecal valve valvuloplasty is used for reconstruction of a pharyngoesophageal defect, and Patch esophagoplasty by using of degradable bioscaffolds of extracellular matrix have shown good results in preclinical and clinical outcomes to prevent stenosis after endoscopic mucosectomy. We will explain the advantages and disadvantages of these different surgical methods in this review article.

Variation of blood supply of hippocampus

Variation of blood supply of hippocampus

2014 Over-the-Scope Clip as Salvage Therapy for Refractory Non-Variceal Upper Gastrointestinal Hemorrhage After Failed Conventional Management: A Case Series

INTRODUCTION: Elderly patients with cardiovascular co-morbidities are of higher mortality risk from non-variceal upper gastrointestinal hemorrhage (NVUGIH). Traditional endoscopic interventions with through-the-scope-clips, electrocautery and epinephrine injections have a high failure rate at managing bleeding from large visible vessels, especially bleeding from posterior duodenal bulb ulcers. Over-the-scope-clips (OTSC) are preferred by endoscopists for their versatile role in repair of fistulas, bowel perforations and NVUGIH. We report two NVUGIH cases where traditional endoscopic and angiographic interventions failed and over the scope clip was used as salvage therapy. CASE DESCRIPTION/METHODS: 85-year-old female with Pulmonary Hypertension and Atrial Fibrillation was admitted for hypovolemic shock from hematemesis. Endoscopy revealed a large posterior duodenal bulb ulcer with adherent clot for which epinephrine injection was used. The ulcer’s size and location prompted angiography and coil embolization of the gastroduodenal artery (GDA). Patient was in hypovolemic shock again due to a massive bleed. She was high risk for surgical intervention due to pulmonary hypertension, and repeat endoscopy was performed for hemostasis. An 11/6 T-type OTSC clip was successfully deployed at a large vessel oozing blood, after removal of a large adherent clot by snare. No further intervention was needed afterward. 76-year-old male with extensive cardiac history was admitted with burns and inhalation injury from a house fire, requiring tracheostomy and gastrostomy placement. During hospitalization, patient had multiple episodes of melena and required blood transfusion. Endoscopy revealed two large anterior and posterior duodenal bulb ulcers, with a visible vessel, managed by electrocautery. Due to persistent bleeding, he underwent coil embolization of the GDA. Two days later, patient had recurrent bleeding. Repeat endoscopy with OTSC was used for successful hemostasis of a large visible vessel in the posterior duodenal bulb. DISCUSSION: Traditional endoscopic management carries a 20% re-bleeding risk and successful secondary hemostasis drops from 90% to 75%. Anatomic variation in blood supply to the duodenal bulb, either from branches of celiac axis or superior mesenteric artery may be the reason why our patients failed angiographic coil embolization of the GDA. To our knowledge, we report the first two cases where OTSC was used for successful salvage of NVUGIH that failed initial endoscopic and angiographic interventions.

Variations in Blood Supply from Proximal to Distal in the Ulnar Collateral Ligament of the Elbow: A Qualitative Descriptive Cadaveric Study

Objectives: The vascular supply of the ulnar collateral ligament (UCL) is unknown. Previous studies have reported varying success in return to play rates after non-operative management of partial UCL tears and suggest a varying healing capacity as possibly related to UCL injury location. The purpose of this study was to analyze the macroscopic vascular anatomy of the ulnar collateral ligament of the elbow. Methods: Eighteen, fresh-frozen, male cadaveric elbows from nine donors were sharply dissected 15 cm proximal to the medial epicondyle. Sixty mL of India Ink was injected through the brachial artery of each elbow. Arms were then frozen at -10°C, radial side down in 15-20° of elbow flexion. A bandsaw was used to section the frozen elbows into 5 mm coronal or sagittal sections. Sections were cleared for visualization using the modified Spalteholz technique. Images of specimens were taken and the qualitative description of the UCL vascularity was undertaken. Results: We consistently found a dense blood supply to the proximal UCL, while the distal UCL was hypovascular. We observed a possible osseous contribution to the proximal UCL from the medial epicondyle in addition to an artery from the flexor/pronator musculature that consistently appeared to provide vascularity to the proximal UCL. The degree of vascular penetration moving from proximal to distal in the UCL ranged from 39-68% of the overall UCL length, with a 49% average length of vascular penetration of the UCL. Conclusion: Our study found a difference in the vascular supply of the ulnar collateral ligament. The proximal UCL was well vascularized, while the distal UCL was hypovascular. This difference in vascular supply may be a factor in the differential healing capacities of the UCL based on the location of injury. An improved understanding of the macroscopic vascular supply of the UCL may aid in the clinical management of partial UCL tears and suggest an indication for treatments with respect to location of UCL injuries.

Abdominal aortic aneurysm and horseshoe kidney-open surgical repair: A case report

Introduction. Horseshoe kidney (HSK) is a congenital anomaly of embryonic kidneys, which occurs in early gestation when both kidneys are in close proximity. This hap-pens as a result of abnormal migration of nephrogenic cells. The presence of HSK may complicate an anterior approach to reconstructive surgery of the aorta and iliac vessels because the isthmus of the HSK lies across the aorta. HSK is often associated with anomalous renal vessels. Case report. A 71-year-old female patient was admit-ted with an abdominal aortic aneurysm, 50 mm in diameter, and HSK, and multiple aberrant renal vessels with subocluded upper left renal artery as seen on the multidetector computed tomography (MDCT). Open surgical treatment was applied. Endarterectomy of the left upper renal artery, perfusion of the right common bottom pole renal artery, and reimplantation of both bottom polar renal arteries were done. Isthmus was not divided. The co-existence of HSK and abdominal aortic aneurysm (AAA) is a rare condition. It presents a technical challenge to vascular surgeons because the surgical treatment of such an aneurysm is complicated due to the abnormal anatomy, difficulties in exposing the aneurysm, and a variable blood supply to the isthmus and lower poles of the HSK. Conclusion. Open surgical repair of AAA with HSK is a successful method and provides good exposure, the possibility of renal circulation preservation, and prevention of renal insufficiency.

Variations in Blood Supply From Proximal to Distal in the Ulnar Collateral Ligament of the Elbow: A Qualitative Descriptive Cadaveric Study

Background: The vascular supply of the ulnar collateral ligament (UCL) is unknown. Previous studies reported varying success in return-to-play rates after nonoperative management of partial UCL tears and suggested a varying healing capacity as possibly related to the location of the UCL injury. Purpose: To analyze the macroscopic vascular anatomy of the UCL of the elbow. Study Design: Descriptive laboratory study. Methods: Eighteen fresh-frozen male cadaveric elbows from 9 donors were sharply dissected 15 cm proximal to the medial epicondyle. Sixty milliliters of India ink was injected through the brachial artery of each elbow. Arms were then frozen at −10°C, radial side down, in 15° to 20° of elbow flexion. A band saw was used to section the frozen elbows into 5-mm coronal or sagittal sections. Sections were cleared for visualization with the modified Spalteholz technique. Images of the specimens were taken, and qualitative description of UCL vascularity was undertaken. Results: The authors consistently found a dense blood supply to the proximal UCL, while the distal UCL was hypovascular. They also observed a possible osseous contribution to the proximal UCL from the medial epicondyle in addition to an artery from the flexor/pronator musculature that consistently appeared to provide vascularity to the proximal UCL. The degree of vascular penetration from proximal to distal in the UCL ranged from 39% to 68% of the overall UCL length, with a 49% mean length of vascular penetration of the UCL. Conclusion: This study found a difference in the vascular supply of the UCL. The proximal UCL was well vascularized, while the distal UCL was hypovascular. This difference in vascular supply may be a factor in the differential healing capacities of the UCL based on the location of injury. Clinical Relevance: An improved understanding of the macroscopic vascular supply of the UCL may aid in the clinical management of partial UCL tears and suggests an indication for these treatments with respect to location of UCL injuries.

Digital Subtraction Angiography of Anterior Cerebral Artery Complex in Indian Population at Two Tertiary Super-Specialty Hospitals

Background: Cerebral circulation has different variations in blood supply. Anterior cerebral artery is an important terminal branch of internal carotid artery. It forms the anterior component of circle of Willis along with the anterior communicating artery. The knowledge of anatomical variations in anterior cerebral artery is of considerable help to clinicians.Objective: The purpose of the study is to find out common anatomical variations of anterior cerebral artery complex by digital subtraction angiography in Indian population.Methodology: This descriptive cross-sectional study was conducted in the Neurointervention department of Max Super-specialty Hospital, New Delhi and Neo Multi-specialty Hospital, Noida, India during July 2016 to December 2016 for a period of six (06) months. Patients admitted in the Neurointervention department for digital subtraction angiography (DSA) were included in this study. Sampling technique was purposive. The angiogram machine was SIEMENS Artis Zee system and framing rate was 4f/sec. Morphology and variations of the anterior cerebral arteries and the anterior communicating artery were studied in 75 patients undergone cerebral DSA.Results: Variations were found in 48% (n=36). Variations of the segments in relation with size, course, communications and terminations of the anterior cerebral artery (ACA) were noted. These were divided into different groups like hypoplasia, aplasia, duplication and fenestrations. Hypoplasia/Aplasia of proximal anterior cerebral artery (A1) was 13.3% in right side and 5.3% in left side. Anterior communicating artery (AComA) was found absent in 10.7% and fenestration in 12%. Callosomarginal artery was found absent in 1.3% in right side and 5.3% in left side. In right callosomarginal artery 6.8% had abnormal origin and 4.2% abnormal in left side. Pericallosal artery was present 100% on both sides.Conclusion: Variations of anterior cerebral artery complex anatomy is found common in Indian population. Among them hypoplasia/aplasia is most commonJournal of National Institute of Neurosciences Bangladesh, 2018;4(1): 12-17

Stroke Mimics: The Quest for Leptomeningeal Anastomoses and Isolated Diffusion-Weigthed MR Signal

Stroke is caused by occlusion of a medium- or large-sized vessel in the brain. The treatment with either intravenous or intra-arterial thrombolysis is based on an accurate and time-sensitive diagnosis. On clinical and imaging grounds a number of entities-seizures, toxic-metabolic, infectious, or demyelinating diseases-can mimic stroke. Identifying them is paramount as the treatment differs significantly. Prior imaging reviews have focused on the nonterritorial distribution of these mimics. However, some important questions arise here. Are the vascular territories and their boundaries invariable in the human brain? Where should we draw the lines separating arterial territories? van der Zwan and colleagues addressed these questions decades ago. For him and others, the leptomeningeal anastomoses-a contentious concept for some but increasingly linked to collateral flow in stroke-is an important anatomic structure with significant variations in their distribution and pathophysiology. Variations in blood supply appear larger that traditionally taught. We revisit this concept and entertained their implications in cases of stroke mimics. For instance, the distribution of abnormalities in some toxic-metabolic processes appear to correlate with areas where rich leptomeningeal anastomoses are expected. We will also explore the concept of hyperintense signal on diffusion weighted-imaging with no correlated changes on apparent diffusion coefficient maps. We name this finding as "isolated DWI signal" and lay-out its importance in the recognition of many entities mimicking stroke. Taking together, the discussed anatomic and imaging concepts will help radiologists and clinicians to recognize not only the common but the unusual entities imitating stroke in the emergency room.

The Use of Fluorescence Angiography During Laparoscopic Sleeve Gastrectomy.

Background and Objectives:A new technology involving indocyanine green (ICG) fluorescence angiography has been introduced to assess tissue perfusion and perform vascular mapping during laparoscopic surgery. The purpose of this study was to describe the use of this technology to identify the variable blood supply patterns to the stomach and gastroesophageal (GE) junction during laparoscopic sleeve gastrectomy (LSG), which may help in preserving the blood supply and preventing ischemia-related leaks.Methods:Eighty-six patients underwent LSG and were examined intraoperatively with fluorescence angiography at an academic bariatric center from January 2016 to September 2017. Before the construction of the SG, 1 mL ICG was injected intravenously, and near infrared fluorescence imaging technology was used to identify the blood supply of the stomach. Afterward, the LSG was created with attention to preserving the identified blood supply to the GE junction and gastric tube. Finally, 3 mL ICG was injected to ensure that all the pertinent blood vessels were preserved.Results:Eighty-six patients successfully underwent the laparoscopic procedure with no complications. The following patterns of blood supply to the GE junction were found: (1) a right-side–dominant pattern (20%), arising from the left gastric artery; (2) a right-side–accessory pattern (36%), running in the gastrohepatic ligament and comprising either an accessory hepatic artery or an accessory gastric artery; and (3) a left-side accessory pattern arising from tributaries from the left inferior phrenic artery significantly contributing to the right-side blood supply. In addition, in 10% of the cases both right and left accessory patterns were present simultaneously.Conclusion:ICG fluorescence angiography allows determination of the major blood supply to the proximal stomach before any dissection during sleeve gastrectomy, so that an effort can be made to avoid unnecessary injury to these vessels during the procedure.

Robotic-assisted Laparoscopic Partial Nephrectomy in a Horseshoe Kidney. A Case Report and Review of the Literature

Horseshoe kidney is a rare renal fusion anomaly, and because of limited mobilization of the kidney and its multiple arterial blood supplies, minimally invasive surgery for renal tumors can be challenging. We describe a case of a right-side oncocytoma in a horseshoe kidney managed robotically and review the literature of robotic-assisted laparoscopic surgical resection of kidney tumors in renal fusion anomalies. Robotic-assisted laparoscopic partial nephrectomy in a horseshoe kidney is feasible. Fusion-related limited mobility during the procedure, as well as an extremely variable blood supply, require meticulous planning. Multi-phase computed tomography and interactive 3D anatomical models are helpful tools to prepare for surgery.

Laparoscopic Pyeloplasty in children with Horseshoe Kidney

ABSTRACTIntroduction Horseshoe kidney occurs in 1 per 400-800 live births and are more frequently observed in males (M:F 2:1). Ureteropelvic junction obstruction (UPJO) is commonly associated with horseshoe kidneys. The variable blood supply, presence of the isthmus and high insertion of the ureter contribute to this problem.Case report An asymptomatic 6 year-old boy presented with antenatal hydronephrosis. Ultrasonography and CT scan demonstrated left UPJO associated with a horseshoe kidney. DMSA showed 33% of function on the left side. DTPA showed a flat curve and lack of washout. A left dismembered laparoscopic pyeloplasty was performed after identification of crossing vessels and abnormal implantation of the ureter. After one year, the child is asymptomatic. DTPA demonstrated a good washout curve.Results Our cohort consisted of six patients, five males and one female, with a mean age of 6 years (range 6m-17 years) and a mean follow-up of 3 years. Ureteropelvic junction obstruction was more common on the left side. Symptoms appeared only in 34% of the cases. Mean operative time was 198 minutes (range 120-270 minutes). Crossing vessels were common (observed in 50% patients). High implantation of ureter was seen in 67% patients and intrinsic obstruction in 83%. Surgical difficulties were found in two cases. Hospital stay was 4.3 days (3 to 6 days), with only one patient having a mild complication (pyelonephritis). All cases had clinical and radiologic improvement.Conclusion Laparoscopic pyeloplasty is safe and feasible in children with UPJO in horseshoe kidneys, with good results and minimal morbidity.

Variations in blood supply to kidney, suprarenal gland and gonad – its clinical importance and embryological basis

Variations in blood supply to kidney, suprarenal gland and gonad – its clinical importance and embryological basis

Colon Reconstruction and Esophageal Reconstructive Surgery

Esophageal reconstruction using colon graft was investigated in this review. Since the first use of the colon for esophageal reconstruction by Kelling and Vulliet, the colon reconstruction became a reliable surgical option to reconstruct partially or totally the esophagus. Over the time, the efficacy of colon graft has been thoroughly evaluated and definitively attested by competent surgeons during the past three decades. The mortality has been significantly improved however the early morbidity is still slightly higher compared to gastric reconstruction. Despite the increased operative time and number of anastomoses, the advantages of a colon graft become apparent including its relatively straight mesentery, its status as an enough long graft to be pulled up to the neck, its low incidence of disease, its resistance gastroesophageal reflux and its long-term good functional results. Compared to right colon, the left colon has less variation in blood supply and a smaller lumen diameter which matches perfectly with esophageal lumen. Colon reconstruction in an isoperistaltic fashion is the standard in order to prevent regurgitation and improve food transit. The posterior mediastinum and the substernal route are the most commonly route used in esophageal reconstruction. However in case of substernal colon reconstruction, as recommended by authors, the thoracic inlet should be enlarged by the partial remove of the manubrium and the left clavicle to ensure there is no compression on the transposed graft at the level of the thoracic inlet. The selection of appropriate colon graft should be based on the adequacy of blood supply and the length of reconstruction. Thereafter microvessel anastomosis should be added in cases where graft ischemia might occur.

English

Appendicectomy is a common surgical procedure worldwide and it refers to the surgical removal of the vermiform appendix for therapeutic reasons. This surgical procedure when performed classically or laparoscopically requires thorough knowledge of surface, gross and vascular anatomy of the vestigial organ. Deficiency in knowledge of variations in blood supply of the appendix can prove to be a problem for the operating surgeon.

A pilot study of cerebral tissue oxygenation and postoperative cognitive dysfunction among patients undergoing coronary artery bypass grafting randomised to surgery with or without cardiopulmonary bypass*.

Coronary artery bypass surgery, performed with or without cardiopulmonary bypass, is frequently followed by postoperative cognitive decline. Near-infrared spectroscopy is commonly used to assess cerebral tissue oxygenation, especially during cardiac surgery. Recent studies have suggested an association between cerebral desaturation and postoperative cognitive dysfunction. We therefore studied cerebral oxygen desaturation, defined as area under the cerebral oxygenation curve < 40% of > 10 min.%, with respect to cognitive performance at 4 days (early) and 3 months (late) postoperatively, compared with baseline, using a computerised cognitive test battery. We included 60 patients, of mean (SD) age 62.8 (9.4) years, scheduled for elective coronary artery bypass grafting, who were randomly allocated to surgery with or without cardiopulmonary bypass. Cerebral desaturation occurred in only three patients and there was no difference in cerebral oxygenation between the two groups at any time. Among patients who received cardiopulmonary bypass, 18 (62%) had early cognitive decline, compared with 16 (53%) in the group without cardiopulmonary bypass (p = 0.50). Three months after surgery, 11 patients (39%) in the cardiopulmonary bypass group displayed cognitive dysfunction, compared with four (14%) in the non-cardiopulmonary bypass group (p = 0.03). The use of cardiopulmonary bypass was identified as an independent risk factor for the development of late cognitive dysfunction (OR 6.4 (95% CI 1.2-33.0) p = 0.027. In conclusion, although cerebral oxygen desaturation was rare in our population, postoperative cognitive decline was common in both groups, suggesting that factors other than hypoxic neuronal injury are responsible.

Laparoscopic Nephrectomy for Renal Cell Carcinoma in a Pelvic Kidney

Introduction: The incidence of pelvic kidney is 1 in 3000, and therefore the finding of a renal cell carcinoma in a pelvic kidney is exceptionally rare, with very few cases previously described. Laparoscopic nephrectomy represents a surgical approach that is minimally invasive, allowing a faster recovery and reduced hospital stay. Materials and Methods: A 68-year-old man underwent an ultrasound scan, which incidentally revealed a tumor in the pelvic kidney. CT scanning confirmed a 4.8 cm tumor in the left pelvic kidney with no evidence of metastatic disease. A 5.5 cm abdominal aortic aneurysm was also identified. Further analysis of the CT demonstrated the blood supply to be mainly from the left common iliac artery and vein, with an accessory vein passing behind the right common iliac artery, draining into the inferior vena cava. Consideration was given to partial nephrectomy, but given the size of the tumor and potentially unpredictable vascular supply, it was felt best to proceed with laparoscopic nephrectomy. Results: The procedure was carried out successfully with minimal blood loss. The operative time was 125 minutes, and length of stay in the hospital was 3 days. A camera port was positioned just below the umbilicus with two further ports triangulated around the kidney. A fourth port was inserted more laterally for retraction purposes. The challenging aspects of the procedure were in mobilizing the sigmoid colon and dissection of the hilar vessels. Conclusion: To the best of the authors knowledge, this is the first video description of a laparoscopic pelvic nephrectomy. The laparoscopic approach for renal cell carcinoma in a pelvic kidney is a safe and effective means of performing nephrectomy, with the advantages of minimally invasive surgery. Given the extremely variable blood supply, sound preoperative knowledge of the vessels and their origin is important. No competing financial interests exist. Runtime of video: 10 mins 00 secs

Reconstruction of the Trachea

This article reviews established methods of autologous tracheal reconstruction, the various synthetic prostheses that have been used in clinical practice, and briefly describes the latest developments in stem cell tracheal bioengineering and allogeneic tracheal transplantation. Reconstruction of the trachea is challenging due to its part cervical part thoracic location, proximity to major vessels, variable blood supply, and its constant colonization with bacteria. In cases of limited resection, primary anastomosis, autologous patch grafts, local advancement rotation flaps, and locoregional cutaneous and muscle flaps will often suffice. In more extensive resections, complex composite microsurgical reconstruction with a radial forearm free flap with cartilage grafts for skeletal support has proven to be viable and reliable. Synthetic tracheal prostheses, solid as well as porous, have been trialed with disappointing results. Infection, dislodgement, migration, and obstruction are not uncommon. Reconstruction with the cadaveric tracheal allografts and aortic allografts continue to be fraught with complications, specifically graft infections. Tracheal bioengineering and tracheal allotransplantation have emerged relatively recently. Despite early promising results, long-term outcome data on these new techniques are still lacking.

Esophageal reconstruction with colon tissue

The present best practice for performing esophageal reconstruction using colon tissue was investigated in this review. The left colon has advantages in that it has less variation in blood supply and a smaller diameter than the right colon; however, the rate of graft necrosis is higher for the left colon. Additional microvascular anastomosis, which is unnecessary in most cases, may be able to resolve these issues. The colon graft should be reconstructed in an isoperistaltic fashion whenever possible in order to prevent regurgitation and improve food transit. The posterior mediastinum has the advantage of being the shortest route, but it also has the major disadvantage that graft necrosis can be severe or fatal if it occurs. In palliative or advanced cases, a retrosternal or subcutaneous route is preferred, because the posterior mediastinum is a tumor bed. However, in these cases partial excision of the manubrium and the left clavicula should be considered to release compression of the graft at the thoracic inlet. Consequently, the selection of the colon graft should be flexible and be based on the inspection of blood supply and the length needed, and thereafter microvessel anastomosis should be added in cases where graft ischemia might occur.