© Turkish Society of Radiology 2011 T he surgical use of the colon as an esophageal substitute plays an important role in esophageal reconstruction, especially when the stomach is unavailable for use. Colonic interposition may be the only surgical option in various situations, such as when prior gastric surgery precludes use of the stomach; when total gastrectomy accom- panies esophageal resection; or as a salvage procedure when previous gastroplasty fails. The advantages of using the colon include its length, acid resistance, and typically rich blood supply. The disadvantages, as compared with gastric pull-up surgery, include the long operating time caused by mobilization of the colon and an additional anastomosis, both of which increase the risk of complications (1). The preservation of an adequate blood supply is one of the most im- portant factors governing the success of colonic interposition grafts. Graft ischemia and anastomotic breakdown, two of the most serious and potentially lethal complications, are both typically related to arterial or venous insufficiency of the interposed segment. Thus, some investiga- tors recommend preoperative angiography to evaluate the vascular sup- ply of the proposed conduit as a means of reducing complications re- lated to compromised blood supply (2). The routine use of preoperative angiographic assessment of the colon- ic arterial supply is controversial, but some institutions use it to assess arterial patency. Additionally, preoperative angiography can be used to identify an anomalous or aberrant vascular supply to the colon, and thereby guides the selection of reconstruction options. The aim of this study was to report our experience with preoperative angiography in patients being evaluated for esophageal reconstruction and to compare our findings with previously reported results. Specifically, we examined the utility of preoperative angiography to the surgeon. Materials and methods This retrospective study was compliant with the US Health Insurance Portability and Accountability Act and was approved by our Institutional Review Board with a waiver of informed consent. Using the search term “mesenteric angiogram,” we performed a search of the radiology elec- tronic database at our institution, which contains over 10 million stud- ies. We limited our search to a 10-year period, from January 1, 2001 to December 31, 2010. We included all patients who had undergone an- giography before esophageal reconstruction. We identified 54 patients who fulfilled our search criteria: 41 male patients and 13 female patients with a mean age at the time of esophageal reconstruction of 58.6 years (range, 26–80 years). Two interventional radiologists reviewed the im- ages from each study. The diagnostic angiograms in the study were performed following standard protocols. The patient is placed on the angiographic table in INTERVENTIONAL RADIOLOGY ORIGINAL ARTICLE Role of preoperative angiography in colon interposition surgery Shaunagh McDermott, Amy Deipolyi, Thomas Walker, Suvranu Ganguli, Stephan Wicky, Rahmi Oklu From the Division of Vascular Imaging and Interventions, Department of Radiology (R.O.  roklu@partners.org ), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. Received 13 August 2011; revision requested 22 August 2011; revision received 11 September 2011; accepted 18 September 2011. Published online 4 January 2012 DOI 10.4261/1305-3825.DIR.4986-11.1 PURPOSE The aim of this study was to evaluate the role of preoperative angiography in patients undergoing colonic interposition. MATERIALS AND METHODS We searched the electronic database of our radiology depart- ment for the term “mesenteric angiography” over a 10-year period from January 1, 2001 to December 31, 2010. RESULTS We identified 54 patients who had undergone mesenteric angiography before esophageal reconstruction, 16 of whom proceeded to have colonic interposition surgery. One patient (6.3%) developed graft necrosis, two (12.5%) developed an anastomotic leak, and three (18.8%) developed an anasto- motic stricture. These complication rates are similar to those reported in the surgical literature for patients who did or did not undergo routine preoperative angiography. CONCLUSION There is no significant difference in the rates of complications secondary to ischemia (graft necrosis, anastomotic stricture, and anastomotic leak) in patients who undergo routine pr- eoperative angiography as compared with those who do not. Key words:  angiography  surgical anastomosis  colon  esophageal neoplasms Diagn Interv Radiol 2012; 18:314–318