Risk-Assessment of Esophageal Surgery: Diagnosis and Treatment of Celiac Trunk Stenosis.

Anastomotic leakage of the gastric conduit following surgical treatment of esophageal cancer is a life-threatening complication. An important risk factor associated with anastomotic leakage is calcification of the supplying arteries of the gastric conduit. The patency of calcified splanchnic arteries cannot be assessed on routine computed tomography (CT) scans for esophageal cancer and, as such, in selected patients with known or assumed mesenteric artery disease, additional CT angiography of the abdominal arteries with 1 mm slices is strongly encouraged. If the mesenteric perfusion is compromised in patients with resectable esophageal cancer, angioplasty procedures with stenting of the mesenteric arteries could be performed to prevent possible ischemia of the gastric conduit.

Biological characterisation of vascular grafts cultured in a bioreactor.

In this study, the development is described of a tissue-engineered construct mimicking the structure of a natural blood vessel. Smooth muscle cells (SMC) were cultured under pulsatile flow conditions in porous tubular scaffolds composed of crosslinked type I insoluble collagen and insoluble elastin. Under these dynamic culture conditions, average wall shear rate, systolic and diastolic pressures and pressure wave-forms comparable to conditions in the human carotid artery were obtained. Culturing of SMC in tubular scaffolds under dynamic conditions resulted in enhanced tissue formation compared to static conditions. Higher SMC numbers, a more homogeneous distribution of SMC throughout the scaffolds and higher collagen mRNA expression levels were found when cells were cultured under dynamic compared to static conditions. mRNA expression levels of markers of proliferation and apoptosis showed that the higher cell numbers in the scaffolds cultured under dynamic conditions can be explained by increased cell proliferation but not by decreased apoptosis. Glucose consumption and lactate formation by the cells showed that cell metabolism was more aerobic under dynamic compared to static conditions. Lining of the dynamically cultured constructs with a luminal monolayer of endothelial cells might result in vessels suitable for in vivo applications.