MEDIUM-TERM PATENCY AND ANATOMIC CHANGES AFTER DIRECT BRONCHIAL ARTERY REVASCULARIZATION IN LUNG AND HEART-LUNG TRANSPLANTATION WITH THE INTERNAL THORACIC ARTERY CONDUIT

Objective: Our purpose was to study the 2-year patency of direct bronc hial artery revascularization in lung transplantation. We wanted to cl arify whether the revascularized bronchial artery system is functional after 2 years, whether bronchial artery vascularity changes with time , and whether posttransplantation bronchial artery disease is arteriog raphically evident after 2 years, Methods: Bronchial artery revascular ization is performed by anastomosing the internal thoracic artery to a s many bronchial artery orifices in the donor descending aorta as poss ible. Twenty-three patients surviving 2 years or more have had interna l thoracic artery-bronchial arteriography performed 1 month and 2 year s after transplantation. One-month and a-year arteriograms have been c ompared. Results: Two-year patency of the internal thoracic artery con duit was 100%. The appearance of the bronchial arteries was unchanged after 2 years in 11 patients. A unilateral or bilateral increase in va scularity was found in two and seven patients, respectively. In three patients new vessels, not visible on the first arteriogram, had appear ed. In four patients one or more small vessels visible on the first ar teriogram had disappeared on the second arteriogram. We have found no arteriographic signs of bronchial artery disease, such as stenosis of the bronchial arteries, and no arteriographic evidence of arterioscler otic disease in the internal thoracic artery. Conclusion: The internal thoracic artery is an excellent conduit for bronchial artery revascul arization, with a 2-year patency of 100% in 23 patients, Only minor ch anges in the bronchial arteriograms have been found.