Surgical and arteriographic results of bronchial artery revascularization in lung and heart lung transplantation.
BACKGROUND
On the basis of our experience with bronchial artery revascularization (BAR) in lung transplantation since its introduction in Copenhagen in 1992, a description of the surgical anatomy of the bronchial arteries and the results of attempted BAR in these patients will be presented.


METHODS
Since June 1992, BAR was performed in 50 en bloc double lung, six single lung, and nine heart-lung transplantations. The location, number, type, and size of each bronchial artery identified and revascularized were recorded. Our choice of conduit for BAR was the internal mammary artery. Routine internal mammary-bronchial arteriography was performed early after the transplantation to evaluate the result of BAR. All arteriograms were carefully studied together with the surgical records. The arteriographic results after attempted BAR were classified as complete, incomplete (bilateral, hemilateral, or poor), or failed. The surgical and arteriographic anatomy of the bronchial arteries has been described, and nomenclature for the as yet unnamed bronchial arteries has been developed.


RESULTS
During surgery 128 bronchial arteries were identified in the descending aorta of the 64 donor lung blocs. Internal mammary-bronchial arteriography was performed in 53 patients. BAR was complete in 32, incomplete in 18, and failed in 3. The number of bronchial arteries identified and revascularized in each case increased with experience. The central and intrapulmonary bronchial artery anatomy was described, and different patterns have been identified.


CONCLUSIONS
Bronchial artery identification is reliable, but a learning process is involved. BAR is possible with a high success rate. Complete BAR is an obtainable goal in most cases.
Nørgaard
M A
MA
Department of Thoracic Surgery RT, Heart Center of Rigshospitalet, Copenhagen, Denmark.
Efsen
F
F
Arendrup
H
H
Olsen
P S
PS
Svendsen
U G
UG
Pettersson
G
G
D000714:Anastomosis, Surgical / Q000379:methods*; D000792:Angiography; D001980:Bronchi / Q000098:blood supply*; D001981:Bronchial Arteries / Q000000981:diagnostic imaging / Q000601:surgery*; D016027:Heart Transplantation / Q000379:methods*; D016041:Heart-Lung Transplantation / Q000379:methods*; D006801:Humans; D016040:Lung Transplantation / Q000379:methods*; D008323:Mammary Arteries / Q000000981:diagnostic imaging / Q000601:surgery; D008866:Microsurgery / Q000379:methods; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D012016:Reference Values; D009626:Terminology as Topic