A Preoperative Vascular Imaging Protocol for Planning of Supercharged Jejunal Conduits in Pediatric Esophageal...

Esophageal replacement (ER) in pediatric patients is complex, and while gastric or colonic interpositions are common, they carry long-term complications. Supercharged jejunal interposition (JI) offers better function but is technically challenging due to variable vasculature. We describe a protocol using computed tomography angiography (CTA) and 3D reconstruction to optimize surgical planning and vessel selection.

A retrospective review of patients undergoing supercharged JI for ER was conducted. Preoperative CTA of the chest and neck assessed the internal thoracic arteries/veins (ITA/ITV) and secondary venous options, including cephalic (CV) and external jugular veins (EJV). CTA with 3D segmentation of the superior mesenteric vasculature mapped jejunal branching patterns.

Thirteen patients underwent supercharged JI with CTA-based planning. The median age was 4.9 years (range: 1.5-15.5). Bilateral ITA visualization was achieved in all patients, and all underwent supercharge to the ITA. ITVs were visualized with lower resolution. Ten patients underwent venous anastomosis to the ITV. The CV was used three times due to insufficient ITV size. Of 26 potential vessels, 42% of CVs and 15% of EJVs were insufficient for use. Five patients underwent mesenteric imaging with 3D reconstruction which identified significant vascular variability. Preoperative vessel mapping correlated with intraoperative findings and reduced extensive mesenteric dissection.

Preoperative CTA with 3D vascular modeling facilitates recipient and donor vessel selection, optimizes surgical planning, and may improve operative efficiency and outcomes in pediatric supercharged JI.