Functional capillary density in ischemic conditioning: implications for esophageal resection with the gastric conduit

Mittermair, Christof; Alexander, Klaus; Scheidl, Stephan; Maglione, Manuel; Hermann, Michael; Margreiter, Raimund; Nguyen, Ningh; Weiß, Helmut

doi:10.1016/j.amjsurg.2007.07.025

Cited by 17 publications

(25 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Ischemic conditioning of the stomach prior to esophagectomy provides a means to obviate this reduction in perfusion; the improvements, however, are not immediate. In an opossum animal model of gastric ischemic conditioning, Reavis et al showed that it took 28 days before gastric perfusion returned to baseline levels after gastric devascularization.Mittermair et al, using a rodent model, showed significant decrease in perfusion of the stomach after ligation of the left and short gastric vessels. They demonstrated that the perfusion of the stomach did not return to pre‐vessel ligation levels for average of 56 days.…”

Section: Discussionmentioning

confidence: 99%

“…Ureschel et al showed that partial ligation of the gastric vessels led to a reduction of anastomotic dehiscence and increase in wound bursting pressures in a rat model. Another study demonstrated that ligation of the left gastric vessels in a rodent model led to an immediate decrease in gastric perfusion that significantly increased after 28 days and leveled off by 56 days after left gastric vessel ligation . Preclinical studies of gastroesophageal anastomotic healing have demonstrated that an ischemic duration of 30 days or greater resulted in increased anastomotic bursting pressure and tensile strength, but that these benefits were not observed with an ischemic conditioning time of 7 days .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Laparoscopic ischemic conditioning of the stomach increases neovascularization of the gastric conduit in patients undergoing esophagectomy for cancer

Pham

Melton

McLaren

et al. 2017

Journal of Surgical Oncology

View full text Add to dashboard Cite

Background and Objectives Gastric ischemic preconditioning has been proposed to improve blood flow and reduce the incidence of anastomotic complications following esophagectomy with gastric pull-up. This study aimed to evaluate the effect of prolonged ischemic preconditioning on the degree of neovascularization in the distal gastric conduit at the time of esophagectomy. Methods A retrospective review of a prospectively maintained database identified 30 patients who underwent esophagectomy. The patients were divided into three groups: control (no preconditioning, n=9), partial (short gastric vessel ligation only, n=8), and complete ischemic preconditioning (left and short gastric vessel ligation, n=13). Microvessel counts were assessed, using immunohistologic analysis to determine the degree of neovascularization at the distal gastric margin. Results The groups did not differ in age, gender, BMI, pathologic stage, or cancer subtype. Ischemic preconditioning durations were 163±156 days for partial ischemic preconditioning, compared to 95±50 days for complete ischemic preconditioning (p=0.2). Immunohistologic analysis demonstrated an increase in microvessel counts of 29% following partial ischemic preconditioning (p=0.3) and 67% after complete ischemic preconditioning (p < 0.0001), compared to controls. Conclusions Our study indicates that prolonged ischemic preconditioning is safe and does not interfere with subsequent esophagectomy. Complete ischemic preconditioning increased neovascularization in the distal gastric conduit.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Laparoscopic ischemic conditioning of the stomach increases neovascularization of the gastric conduit in patients undergoing esophagectomy for cancer

Pham

Melton

McLaren

et al. 2017

Journal of Surgical Oncology

View full text Add to dashboard Cite

show abstract

“…The upper part of the transposed stomach is particularly at risk from rarefaction of intramural vessels, as demonstrated by anatomical studies [17]. Urschel and others [18][19][20] have explored the role of gastric ischemic conditioning in animals and demonstrated that this may have a potential benefit [21][22][23][24][25][26]. Akiyama in 1992 [27] reported the first human clinical series, and more recent studies have confirmed a beneficial impact of conditioning [28][29][30][31][32][33][34].…”

Section: Introductionmentioning

confidence: 89%

Randomized controlled trial of laparoscopic gastric ischemic conditioning prior to minimally invasive esophagectomy, the LOGIC trial

2012

View full text Add to dashboard Cite

show abstract

“…Animal experiments on gastric conditioning have been conducted to assess the safety and effectiveness of selective vascular interruption. Four animal models were used in these investigations: rats, opossums, dogs, and pigs 7,9–17 . Rats and mice are popular for investigation of some esophageal conditions and techniques; they offer physiologic similarity with humans, and they have been used extensively to study some surgical models for esophageal reconstruction.…”

Section: Experimental Models Used For Ischemic Conditioning Of the Stmentioning

confidence: 99%

“…used the gastric fundus as their target area. Mittermair et al 15 . assessed the blood flow in six different sites, while Jones Beck et al .…”

Section: Experimental Models Used For Ischemic Conditioning Of the Stmentioning

confidence: 99%

Vascular conditioning of the stomach before esophageal reconstruction by gastric interposition

Yuan¹,

Duranceau²,

Ferraro³

et al. 2012

Diseases of the Esophagus

View full text Add to dashboard Cite

Gastric interposition with intrathoracic or cervical esophagogastrostomy is currently the preferred operation for reconstruction after esophagectomy. Anastomotic leaks however result from poor vascular supply to the proximal stomach. They are responsible for significant morbidity and mortality. 'Ischemic conditioning' of the interposed stomach has been proposed as a technique where the 'delay phenomenon' aims at improving the microcirculation of the gastric conduit and preventing anastomotic leakage. Experimental observations and clinical studies have been conducted to document the immediate effects and results of this approach. The aim of this work is to review the principles, pathophysiology, experimental, and clinical evidence related to vascular conditioning of the stomach prior to esophagectomy with gastric interposition and esophagogastric anastomosis. MEDLINE and PubMed were searched to identify articles related to vascular conditioning of the stomach. Cross references were added and reviewed to complete the reference list. The anatomic basis of ischemic conditioning, the prevalence of ischemic events on the gastric conduit, the methodology to assess the microcirculation before and after gastric devascularization, animal experiments, and clinical studies reported on this approach were reviewed. Ten experimental works, eleven clinical observations, four reviews, and two editorial commentaries addressing ischemic conditioning of the stomach were identified and reviewed. Experimental observations document improved microcirculation to the proximal stomach following partial gastric devascularization. Clinical reports show the feasibility and relative safety of gastric ischemic conditioning. Preliminary observations suggest potential improvements to the gastric microcirculation resulting from gastric ischemic conditioning. This approach may help prevent complications at the esophagogastric anastomosis. The actual level of evidence however cannot promote its use outside of clinical research protocols.

show abstract

Functional capillary density in ischemic conditioning: implications for esophageal resection with the gastric conduit

Cited by 17 publications

References 15 publications

Laparoscopic ischemic conditioning of the stomach increases neovascularization of the gastric conduit in patients undergoing esophagectomy for cancer

Laparoscopic ischemic conditioning of the stomach increases neovascularization of the gastric conduit in patients undergoing esophagectomy for cancer

Randomized controlled trial of laparoscopic gastric ischemic conditioning prior to minimally invasive esophagectomy, the LOGIC trial

Vascular conditioning of the stomach before esophageal reconstruction by gastric interposition

Contact Info

Product

Resources

About