Esophageal Arteries

arteriae oesophageales

The esophagus receives a segmental blood supply: cervical esophagus from the inferior thyroid artery; upper thoracic esophagus from direct aortic branches and bronchial artery contributions; middle thoracic from 4-6 direct aortic esophageal branches; lower thoracic from the left inferior phrenic and left gastric arteries. Venous drainage parallels the arterial supply, draining into the azygos (thoracic) and portal system (abdominal), creating the portosystemic junction that becomes varicose in portal hypertension.

Region: Chest

Clinical Relevance

Clinical Notes

The esophageal blood supply watershed at the thoracoabdominal junction makes the distal esophagus vulnerable to ischaemia after extensive esophagectomy mobilisation. The Ivor-Lewis and McKeown esophagectomy relies on preserving the right gastroepiploic arcade for the gastric conduit blood supply after esophageal resection. Esophageal varices from portal hypertension dilate the submucosal esophageal veins at the portosystemic junction, most prominently at the distal esophagus where portal pressure-driven blood flows retrogradely through the left gastric to esophageal veins to reach the azygos.

Pathology

Common Injuries & Conditions

Distal Esophageal Ischaemia After Extended Esophagectomy Mobilisation

Extensive thoracic esophageal mobilisation for esophagectomy devascularises the thoracic esophageal wall by dividing the aortic esophageal branches; the conduit anastomosis must be positioned at the thoracic inlet where the gastric conduit has good blood supply from the right gastroepiploic arcade, avoiding anastomosis in the ischaemic distal esophageal zone.