Three-dimensional CT angiography of anatomic variations in the pulmonary arterial tree

Fourdrain, Alex; Dominicis, Florence De; Blanchard, Chloé; Iquille, Jules; Lafitte, Sophie; Beuvry, Pierre-Louis; Michel, D; Merlusca, Geoni; Havet, É.; Berna, Pascal

doi:10.1007/s00276-017-1914-z

Cited by 35 publications

(40 citation statements)

References 9 publications

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“…Careful preoperative planning using pulmonary imaging techniques in thoracic surgery is essential for positive outcomes [1][2][3] . This is especially true in anatomical lung resection where care has to be taken to avoid injury to the highly vascular hilar structures.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…This is especially true in anatomical lung resection where care has to be taken to avoid injury to the highly vascular hilar structures. Twenty to thirty per cent of patients can present with variable numbers of arterial and venous branches [3][4] . Preoperative imaging of the hilar structures to recognize their position, orientation and relationship with one another will help the surgeon safely dissect and divide the structures during surgery.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

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Operative Planning in Thoracic Surgery: A Pilot Study Comparing Imaging Techniques and Three-Dimensional Printing

Smelt

Suri

Valencia³

et al. 2019

The Annals of Thoracic Surgery

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Background: Careful preoperative planning in thoracic surgery is essential for positive outcomes especially in video assisted thoracic surgery (VATS) where palpation and 3-dimensional imaging is restricted. The objective of this study was to evaluate the ability of different imaging techniques such as Computerized Tomography (CT) scanning, maximal intensity projection (MIP) imaging, 3dimensional (3D) reconstruction as well as 3D printing, to define the anatomy of the hilar structures prior to anatomical lung resection. Methods: All patients undergoing elective lung resections by VATS for cancer under a single surgeon were identified over a three-month period. A single surgeon was asked to record the number of pulmonary artery branches supplying the lobe to be resected using the preoperative CT scan, MIP images and 3D reconstructed CT images. 3 patients had their lung hilum printed. These were then compared to the intraoperative findings. Results: 16 patients had their preoperative imaging analyzed. A further 3 patients had their lung hilum 3D printed. Although not statistically significant, the 3D prints of the hilum were found to be the most accurate measurement with a correlation of 0.92. CT, 3D reconstructed CT and MIP images tended to under recognize the number of arterial branches and therefore scored between 0.26 and 0.39 in terms of absolute agreement with the number of arteries found at operation. Conclusions: 3D printing in the planning of thoracic surgery may suggest a benefit over contemporary available imaging modalities and the use of 3D printing in practicing operations is being established.

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Section: Accepted Manuscriptmentioning

confidence: 99%

Section: Accepted Manuscriptmentioning

confidence: 99%

Operative Planning in Thoracic Surgery: A Pilot Study Comparing Imaging Techniques and Three-Dimensional Printing

Smelt

Suri

Valencia³

et al. 2019

The Annals of Thoracic Surgery

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“…Moreover, a single incision tends to be more acceptable to patients. However, due to the reductions in the number of operating ports and space, UVATS demands higher surgical skill and proficiency from surgeons and their assistants, especially in cases with incomplete lung fissures, anatomic variations of pulmonary vessels, and a large number of calcified lymph nodes (7)(8)(9)(10)(11), and can lead to serious complications, such as unexpected bleeding (12). Therefore, individual preoperative anatomical simulations and detailed planning of surgical procedures are conducive to the safety and feasibility of UVATS.…”

Section: Introductionmentioning

confidence: 99%

Utility of preoperative three-dimensional CT bronchography and angiography in uniportal video-assisted thoracoscopic anatomical lobectomy: a retrospective propensity score-matched analysis

Zhu¹,

Yao²,

Xu³

et al. 2021

Ann Transl Med

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Background: Personalized three-dimensional (3D) reconstruction can help surgeons to overcome technical challenges and variations of pulmonary anatomic structures in the performance of uniportal video-assisted thoracoscopic surgery (UVATS), thus improving the safety and efficacy of the procedure. This study aims to evaluate the utility of preoperative 3D-CT bronchography and angiography (3D-CTBA) with Exoview software in the assessment of anatomical variations of pulmonary vessels, and to analyze short-term surgical outcomes in patients undergoing UVATS lobectomy. Methods:We retrospectively analyzed the data of 198 consecutive patients who underwent curative UVATS lobectomy between November 2019 and September 2020. The patients were divided into an "Exoview" group (n=53) and a "non-Exoview" group (n=145). We performed 1:1 propensity score matching and compared intraoperative and postoperative outcomes between the two groups. A subgroup analysis of 74 patients who underwent single-direction uniportal lobectomy was also conducted. Aberrant pulmonary vessel patterns related to the surgery were also examined. Results:The operative time in the Exoview group was significantly shorter than that in the non-Exoview group, both before (145.7±33.9 vs. 159.5±41.6 minutes, P=0.032) and after (145.7±33.9 vs. 164.2±41.8 minutes, P=0.014) propensity score matching. The number of mediastinal lymph nodes dissected was higher in the Exoview group than in the non-Exoview group (8.19±6.89 vs. 5.78±3.3, P=0.024) after propensity score matching. Intraoperative blood loss showed a statistical difference between the Exoview and non-Exoview groups (60.4±45.4 vs. 100.8±83.9, P=0.009). Four types of arterial variations and 2 types of venous variations related to the surgery were observed among 8 patients (15%), which have rarely been reported before.Conclusions: Personalized preoperative 3D-CT bronchography and angiography helped to clearly visualize the pulmonary anatomical structures and could contribute to the safe and efficient performance of UVATS anatomical lobectomy.

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“…Aberrations of pulmonary vessels and bronchus are troublesome and potentially dangerous which may increase risk of vascular injury and dissection of wrong bronchus during operation (1)(2)(3). Due to the increasing number of lung cancer and lung surgery (4,5), preoperative identi cation of anatomic variation in lung is much important for the operation safety.…”

Section: Introductionmentioning

confidence: 99%

Rare Location and Drainage Pattern of Right Pulmonary Veins and Aberrant Right Upper Lobe Bronchial Branch: a Case Report

Wang

Zhao

Zhang

et al. 2020

Preprint

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BackgroundComplex aberration in lung is rare, which may increase risk of vascular injury and cause ligation of wrong pulmonary vein or bronchus by mistake during lung surgery, and result in sever complication like pulmonary congestion or atelectasis. Case presentationIn this case, a 44-year-old female was admitted for ground glass nodule (maximum diameter, 24mm) in right upper lobe. During operation, it was found that extremely rare aberrations of right preeparterial bronchus, right upper lobe vein behind pulmonary artery and right middle lobe vein drained into left atrium occurred in this patient simultaneously. Video-assisted thoracoscopic right upper lobectomy with lymph nodes dissection was performed for adenocarcinoma shown by frozen section. The patient was well recovered and discharged at the postoperative-day 4. Based on the literature review, such complex aberrations of pulmonary vessels and bronchus had seldom been reported before.ConclusionPreoperatively, three-dimensional reconstruction can help to identify inconspicuous variation of pulmonary vessels and bronchus effectively. During lung surgery, if anatomic aberration is suspected, careful dissection of vessels and bronchus will help to confirm whether there is an aberration or not.

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Three-dimensional CT angiography of anatomic variations in the pulmonary arterial tree

Abstract: The findings of the present CT angiography/3D reconstruction study agreed with the reference works on the anatomy of the pulmonary arterial tree and defined the frequency of anatomic variations. It is essential to assess the anatomy of the pulmonary arterial tree before VATS lobectomy.

Cited by 35 publications

References 9 publications

Operative Planning in Thoracic Surgery: A Pilot Study Comparing Imaging Techniques and Three-Dimensional Printing

Operative Planning in Thoracic Surgery: A Pilot Study Comparing Imaging Techniques and Three-Dimensional Printing

Utility of preoperative three-dimensional CT bronchography and angiography in uniportal video-assisted thoracoscopic anatomical lobectomy: a retrospective propensity score-matched analysis

Rare Location and Drainage Pattern of Right Pulmonary Veins and Aberrant Right Upper Lobe Bronchial Branch: a Case Report

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