ANATOMICAL BASES FOR BRONCHIAL ARTERIAL REVASCULARIZATION IN DOUBLE LUNG TRANSPLANTATION

A study of the bronchial arterial blood supply was conducted to facili tate in surgical attempts of bronchial revascularization in double lun g transplantation. This study consisted of 20 cadaveric anatomical dis sections of the bronchial arterial blood supply as well as a retrospec tive review of 50 bronchial arteriograms. The right bronchial tree was supplied by an artery originating from the right intercostal bronchia l arterial trunk in 76 to 95% of the cases. This artery also supplied the distal trachea and the carina in over 80% of cases as well as the proximal left bronchial tree via a network of small collaterals found in the subcarinal compartment and adventitial tissues located on the a nterior surface of the descending aorta. A common arterial trunk for b oth the right and left bronchial trees was found in 12 of the 20 disse ctions (60%). Left bronchial arteries were much smaller and less consi stent. Proximity of the bronchial arteries orifices was frequently obs erved : in 10 of the 20 dissections it allowed simultaneous reperfusio n of more than one vessel. To maintain the vascular anastomotic networ k in between the right and left trees, extensive vascular dissection a nd carinal resections are prohibited. This will allow revascularizatio n of the whole tracheal bronchial tree via the supply of the origin of the RICBA.