Direct revascularization of bronchial arteries for lung transplantation: An anatomical study

Risk factors for airway complications within the first year after lung transplantation

“…An anatomical study of the bronchial arteries in autopsy cases showed that at least one right bronchial artery arises from the first intercostal artery and that at least one left bronchial artery originates from the descending thoracic aorta [21]. Injection studies of the right intercostobronchial artery pedicle showed a collateral network between the right and the left bronchial arteries.…”

A rare cadaveric finding of ectopic origin of a bronchial artery: surgical and imaging consequences

“…It therefore appears that revascularisation of the RBA should, in theory, be sufficient to supply the distal trachea, carina, and proximal bronchial tree, provided the subcarinal and perioesophageal collateral networks are preserved intact [3]. The descending aorta of the donor is posteriorly opened and the ostium of the RBA is identified and isolated within a patch of aorta to facilitate grafting and finally implanted into the ascending aorta of the recipient [3,9,12]. In case of ectopic origin of the RBA from the RIMA the plan of surgery has to be modified, especially in cases of single lung transplantation, where collateral network circulation does not exist, and the existence of an ectopic bronchial artery may provoke undesirable problems in an already risky operation.…”

The Backflow from the Pulmonary Circulation for Identification of the Aortic Origin of the Bronchial Arteries in Experimental Left Single Lung Transplantation

“…On the other hand, the relevance of bron chial circulation [6] was recognized from the very beginning [9] of the lung transplantation era. Attempts of bronchial revascularization in experimental lung transplantation were carried out, in general with satisfactory re sults, by Metras [9], Bogardus [10], Rabino vich [11], Pinsker et al [12], Mills et al [ 13]; few centers now carry out routinely bronchial artery reconstruction in lung transplantation [14,15].…”

“…18. 24-26] the anatomy of bronchial circula tion is quite unfavorable due to the great vari able number, origin and course of the bron chial arteries; in detail we know from the many close anatomical and bronchial arterio gram studies, that in humans a right bronchial artery originates by the first right intercostal bronchial artery in more than 90% of in stances; this provides an important blood sup ply to the distal trachea, the carina, the right bronchus and also to the left bronchus through a subcarinal periadventitial anasto motic network [14], Moreover, in more than 50% of instances, there are one or two small bronchial arteries that originate from the an terior-lateral aspect of descending aorta, which supplies the left main bronchus with a 'particularly short and rectilinear decourse' [6] and whose orifices are in proximity of the usual origin of the right bronchial artery [14. 24], In dog from the first right intercostal trunk originates a bronchial artery in a per centage (70%) that is inferior to that recorded in humans; this artery vascularizes the right bronchus in 4/5 of cases and the left bronchus in the remaining 1/5 [22,23].…”

“…The problems with this approach are essentially technical, being difficult to identi fy and preserve the bronchial arteries in hu mans, due to their variability in number, ori gin and course [6], Other possible problems could be related to the fact that any additional surgical maneuvers may prolong the lung ischemia time, thus increasing the risk of postoperative graft failure.…”