Direct aortic suture technique for anomalous systemic arterial supply to the basal lung: A retrospective cohort study

Anomalous systemic arterial blood supply to the basal lung (ABLL) is a rare congenital malformation. Although surgical resection is the standard treatment, the surgical techniques for aberrant arteries remain poorly discussed. Herein, we evaluated the efficacy of our direct suture closure technique in preventing aneurysmal changes in aberrant artery stumps through a retrospective review of the medical records of patients who underwent surgical resection of ABLL at our institution between January 2013 and January 2023. The diagnosis of ABLL was based on enhanced computed tomography (CT) findings. To treat ABLL, we performed lateral thoracotomy through the 5^th intercostal space via a ~10 cm skin incision. After anatomical pulmonary resection, the aortic stump of the aberrant artery was sutured directly with a felted non-absorbable thread. In one patient, we further examined the postoperative blood flow using 4D-flow magnetic resonance imaging. Overall, 5 consecutive patients, including four (80%) females with a median age at operation of 59-year-old, were assessed. The median operative time was 166 min, and the median blood loss was 34 ml. There were no cases of perioperative mortality or morbidity, and the median hospital stay was 8 days. No vortex flow was observed in 4D-flow evaluation of blood flow. Histological changes were observed in the aberrant artery, including fibrous intimal thickening, atherosclerosis, intramural thrombus, and collection of foam cells and lymphocytes. Thus, we present this technique as a safe treatment for ABLL that allows for the preservation of blood flow and complete resection of abnormal vessels.