Reconstruction of the Pulmonary Artery

Venuta, Federico; Ciccone, Anna Maria

doi:10.1053/j.semtcvs.2006.05.004

Cited by 28 publications

(22 citation statements)

References 20 publications

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“…The preserved lung lobe contributes remarkably to the pulmonary function and quality of life. The resection and reconstruction of the PA has not achieved wide acceptance until very recently, when this technique was demonstrated to provide oncologically adequate resection [1,2]. In 1967, Gundersen was the first to report a PA sleeve resection.…”

Section: Discussionmentioning

confidence: 98%

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New technique for pulmonary artery reconstruction

Cerezo

Cano

Espinosa

et al. 2009

European Journal of Cardio-Thoracic Surgery

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Bronchial and vascular reconstructive procedures are a technically feasible alternative to pneumonectomy in lung cancer and have the advantage of preserving lung parenchyma function. Sleeve resection and prosthetic reconstruction of the pulmonary artery (PA) have progressively gained acceptance as an alternative to pneumonectomy in lung cancer surgery. To spare the lung parenchyma, angioplastic procedures involving removal of a portion of the arterial wall or a circumferential resection with arterial reconstruction have been used. Several techniques of pulmonary arterioplasty have been documented, such as patch reconstruction, end-to-end anastomosis, synthetic prosthesis, biological prosthesis, prosthetic or pericardial conduit. We present the first case reported in the literature of PA reconstruction with a pulmonary vein graft.

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Section: Discussionmentioning

confidence: 98%

“…Bronchial and vascular reconstructive operations represent alternative procedures to pneumonectomy in different settings of pulmonary surgery [1,2]. Patients at high cardiological or respiratory risk for pneumonectomy are the best candidates for these procedures.…”

Section: Discussionmentioning

confidence: 99%

New technique for pulmonary artery reconstruction

Cerezo

Cano

Espinosa

et al. 2009

European Journal of Cardio-Thoracic Surgery

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“…Various materials are considered for use as conduits. Autologous pericardial roll conduits are popular, 1) with homologous saphenous 4) or et al reported their experience of using a custom-made heterogeneous bovine pericardial conduit. 8) However, postoperative shrinkage or twisting could occur with the use of these materials.…”

Section: Discussionmentioning

confidence: 99%

“…PA reconstruction techniques range from direct oversewing, which is appropriate in cases of limited tangential resection, and pericardial patch closure, which is used when more than one third of the arterial circumference has to be resected, to end-to-end anastomosis (sleeve resection), which is used when the defect affects >50% of the arterial wall. [1][2][3] Interposition of a conduit could be required when the extent of the circumferential PA defect PA Reconstruction with a Prosthetic Conduit pulmonary veins 5,6) serving as possible alternatives. PA sleeve resection and reconstruction with autologous pericardium is thought to be a safe procedure.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Artery Reconstruction with a Prosthetic Conduit in Lung Cancer

Yoshida

Toishi

Agatsuma

et al. 2014

ATCS

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In radical pulmonary resection for advanced lung cancer, reconstruction of the pulmonary artery (PA) can preserve the lung parenchyma. Reconstruction techniques have gained acceptance because they enable the surgeon to avoid pneumonectomy. Various techniques have been documented, such as direct suturing, end-to-end anastomosis, and a patch or conduit reconstruction. We present two lobectomy cases in which the patients underwent PA reconstruction with prosthetic conduits because they were unfit for other procedures. In both cases, the conduits showed good postoperative patency. When interposition of a conduit is required for PA reconstruction, the use of a prosthetic conduit should be considered in selected cases.

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“…Conduit options include autologous pericardium, pulmonary vein, or PTFE. In the presence of concomitant airway injuries, use of interposition muscle flaps may be considered to prevent bronchoarterial fistulas (43)(44)(45)(46)(47). Complex repair of the pulmonary vein is most commonly associated with stapling of a common trunk of the left pulmonary vein.…”

Section: Surgical Prevention and Management Techniquesmentioning

confidence: 99%

Prevention and management of intraoperative crisis in VATS and open chest surgery: how to avoid emergency conversion

Safdie¹,

Sanchez²,

Sarkaria³

2017

J. Vis. Surg.

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Video assisted thoracic surgery (VATS) has become a routinely utilized approach to complex procedures of the chest, such as pulmonary resection. It has been associated with decreased postoperative pain, shorter length of stay and lower incidence of complications such as pneumonia. Limitations to this modality may include limited exposure, lack of tactile feedback, and a two-dimensional view of the surgical field. Furthermore, the lack of an open incision may incur technical challenges in preventing and controlling operative misadventures leading to major hemorrhage or other intraoperative emergencies. While these events may occur in the best of circumstances, prevention strategies are the primary means of avoiding these injuries. Unplanned conversions for major intraoperative bleeding or airway injury during general thoracic surgical procedures are relatively rare and often can be avoided with careful preoperative planning, review of relevant imaging, and meticulous surgical technique. When these events occur, a pre-planned, methodical response with initial control of bleeding, assessment of injury, and appropriate repair and/ or salvage procedures are necessary to maximize outcomes. The surgeon should be well versed in injuryspecific incisions and approaches to maximize adequate exposure and when feasible, allow completion of the index operation. Decisions to continue with a minimally invasive approach should consider the comfort and experience level of the surgeon with these techniques, and the relative benefit gained against the risk incurred to the patient. These algorithms may be expected to shift in the future with increasing sophistication and capabilities of minimally invasive technologies and approaches. hemorrhage within moments. While these events may occur in the best of circumstances, prevention strategies are the primary means of avoiding these injuries. When they do occur, premeditated and expedited intervention is the key to rescue (1). The current report focuses on the prevention and management of these emergency bleeding events in VATS pulmonary resections. Preoperative radiologic assessment of vascular and anatomic variationRigorous preoperative evaluation of fitness of surgery is a key component of any operative assessment. Preoperative identification and awareness of case-specific and patientspecific risk factors may help prevent hemorrhagic complications in most lung resections. These factors include body habitus, preoperative chemotherapy and radiation, bleeding diatheses including medical anticoagulants, previous thoracic surgery, lymph node calcification and/or granulomatous disease, tumor size and location.Computed chest tomography has become a standard of care in virtually all cases considered for major pulmonary resection. These high resolution scans, often available with three dimensional reconstruction, can provide valuable opportunities to identify standard and anomalous vascular variations prior to surgery in greater than 95% of cases (2-6). Imaging may also identify cal...

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Reconstruction of the Pulmonary Artery

Cited by 28 publications

References 20 publications

New technique for pulmonary artery reconstruction

New technique for pulmonary artery reconstruction

Pulmonary Artery Reconstruction with a Prosthetic Conduit in Lung Cancer

Prevention and management of intraoperative crisis in VATS and open chest surgery: how to avoid emergency conversion

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