Direct revascularization of bronchial arteries for lung transplantation: an anatomical study

Direct revascularization of the bronchial arteries for both single-lung and double-lung transplantation would improve airway healing and reduce airway complications after transplantation. We studied the anatomical pattern of bronchial arteries in 30 autopsy cases. In 28 of 30 cases (93.3%), at least one left bronchial artery arose directly from the anterior wall of the descending thoracic aorta. In 25 of the 30 cases (83.3%), at least one right bronchial artery was related to the first right intercostal artery. Injection studies showed that this right intercostobronchial artery supplies the proximal left main bronchus and carina as well as the right bronchus. We developed a technique for extracting the lungs along with the right intercostobronchial artery and a patch of aorta at its origin and applied it to 19 of the dissections. In 17 of the 19 cases studied (89.4%), the right intercostobronchial artery pedicle obtained had a length varying from 6.5 to 8.5 cm, sufficient for attachment of its origin to the ascending aorta of the recipient after double-lung transplantation. The right intercostobronchial artery pedicle provides the possibility for direct bronchial revascularization in right single-lung, double-lung, and lung-heart transplantation. A similar technique, utilizing the left bronchial artery, can be used to revascularize a left lung transplant.