SURGICAL AND ARTERIOGRAPHIC RESULTS OF BRONCHIAL ARTERY REVASCULARIZATION IN LUNG AND HEART-LUNG TRANSPLANTATION

Background: On the basis of our experience with bronchial artery revas cularization (BAR) in lung transplantation since its introduction in C openhagen in 1992, a description of the surgical anatomy of the bronch ial arteries and the results of attempted BAR in these patients will b e presented. Methods: Since June 1992, BAR was performed in 50 en bloc double lung, six single lung, and nine heart-lung transplantations. T he location, number, type, and size of each bronchial artery identifie d and revascularized were recorded. Our choice of conduit for BAR was the internal mammary artery. Routine internal mammary-bronchial arteri ography was performed early after the transplantation to evaluate the result of BAR. All arteriograms were carefully studied together with t he surgical records. The arteriographic results after attempted BAR we re classified as complete, incomplete (bilateral, hemilateral, or poor ), or failed. The surgical and arteriographic anatomy of the bronchial arteries has been described, and nomenclature for the as yet unnamed bronchial arteries has been developed. Results: During surgery 128 bro nchial arteries were identified in the descending aorta of the 64 dono r lung blocs. Internal mammary-bronchial arteriography was performed i n 53 patients. BAR was complete in 32, incomplete in 18, and failed in 3. The number of bronchial arteries identified and revascularized in each case increased with experience. The central and intrapulmonary br onchial artery anatomy was described, and different patterns have been identified. Conclusions: Bronchial artery identification is reliable, but a learning process is involved. BAR is possible with a high succe ss rate. Complete BAR is an obtainable goal in most cases.