Clinically important pulmonary vascular variations: a narrative review

Abstract

Background and Objective Pulmonary vascular variations are a major factor in thoracic surgeries. Minimally invasive techniques, such as video-assisted thoracic surgery (VATS) used in non-small lung cancer treatment, have a limited field of view and no haptic feedback. Additionally, new studies suggest that segmentectomies are beneficial for patients. Accurate knowledge of vascular patterns and variants is crucial for conducting such procedures safely. The aim of this review was to systematize data in a useful manner from studies and case reports concerning pulmonary vascular variations and patterns. Methods We conducted a search on the PubMed and Embase databases. We used classifications of Nagashima, Yamashita, Boyden, Maciejewski, and Shimizu. Key Content and Findings The analysis showed that more data on the incidence rate and vascular patterns of certain bronchopulmonary segments are needed. Venous variations are a major factor in segmental resections, but additional data regarding incidence and pattern types are needed. Surgeons need to be aware of vascular variations as they can influence procedures in seemingly unrelated areas. The majority of studies emphasize the use of three-dimensional (3D) reconstruction of computed tomography (CT) for accurate planning of any thoracic procedures. Conclusions Abnormal vessels pose a risk in various procedures performed within the thorax, and the data in this review could be valuable in different medical areas in this regard.