Bronchial artery revascularization in lung transplantation: techniques, experience, and outcomes.
Summary of "Bronchial artery revascularization in lung transplantation: techniques, experience, and outcomes."
PURPOSE OF
REVIEW:
Lung transplantation (LTX) is routinely performed ignoring the bronchial arteries. In this article, we review the published world experience, including our own, of LTX with direct bronchial artery revascularization (BAR) and describe the anatomy of the bronchial arteries and our surgical technique. RECENT
FINDINGS:
The published experience of LTX with BAR consists of only a few small single-institution series, all with good success rates and outcomes. The bronchial artery anatomy will allow identification of useful arteries for BAR in most donors and double LTX (DLTX) with BAR is almost always possible. For single LTX (SLTX), BAR is feasible in about 50%. The surgical techniques for DLTX and SLTX with BAR has been well described. Our own combined Copenhagen and Cleveland experience, all BAR procedures performed or supervised by G.B.P., include a total of 131 LTX with BAR. BAR was performed with a success rate of over 90%, DLTX 95%. Success was uniformly associated with normal airway healing and the overall Copenhagen 5 and 10-year survival for DLTX with BAR was superior to that reported by other institutions after sequential bilateral lung transplantation.
SUMMARY:
LTX with BAR is feasible, successful and well tolerated. Success ensures normal airway healing. The Copenhagen experience suggests possible long-term survival benefit inviting to a multicenter study to define the role of BAR in LTX.
Affiliation
aDepartment of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA bHjerte-Lungekirurgisk Afdeling T, Aalborgs Sygehus Aarhus Universitetshospital, Aalborg, Denmark.
Journal Details
This article was published in the following journal.
Name: Current opinion in organ transplantation
ISSN: 1531-7013
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/20689432
- DOI: http://dx.doi.org/10.1097/MOT.0b013e32833e16fc
Medical and Biotech [MESH] Definitions
Cerebral Revascularization
Microsurgical revascularization to improve intracranial circulation. It usually involves joining the extracranial circulation to the intracranial circulation but may include extracranial revascularization (e.g., subclavian-vertebral artery bypass, subclavian-external carotid artery bypass). It is performed by joining two arteries (direct anastomosis or use of graft) or by free autologous transplantation of highly vascularized tissue to the surface of the brain.
Gastroepiploic Artery
Abdominal artery that follows the curvature of the stomach. The right gastroepiploic artery is frequently used in CORONARY ARTERY BYPASS GRAFTING; MYOCARDIAL REVASCULARIZATION, and other vascular reconstruction.
Internal Mammary-coronary Artery Anastomosis
Direct myocardial revascularization in which the internal mammary artery is anastomosed to the right coronary artery, circumflex artery, or anterior descending coronary artery. The internal mammary artery is the most frequent choice, especially for a single graft, for coronary artery bypass surgery.
Bronchial Arteries
Left bronchial arteries arise from the thoracic aorta, the right from the first aortic intercostal or the upper left bronchial artery; they supply the bronchi and the lower trachea.
Epigastric Arteries
Inferior and external epigastric arteries arise from external iliac; superficial from femoral; superior from internal thoracic. They supply the abdominal muscles, diaphragm, iliac region, and groin. The inferior epigastric artery is used in coronary artery bypass grafting and myocardial revascularization.
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