Histological Evaluation of Human Pulmonary Artery Intimal Damage Caused by Various Clamp Techniques

We evaluated intimal damage at the histological level resulting from various clamp techniques in human pulmonary artery (PA) specimens obtained after lobectomy.

We prospectively analysed patients who underwent anatomical lung resection at 2 centres between April 2021 and March 2025. The double-loop technique (DLT), DeBakey vascular clamp (third and fourth notches), Fogarty vascular clamp (second notch), endovascular clips (gold and silver), and vessel loop technique (VLT) were evaluated. PA specimens with an external diameter ≥10 mm were included. We measured the burst pressure and evaluated the intimal damage in the human PA by using the modified Zhang's score (MZS; 0-5).

Thirty-six patients were enrolled, and 70 PA samples were obtained. DeBakey vascular clamp at the third notch (DeBakey 3rd) exerted a significantly higher burst pressure than did DLT (P = 0.022). No significant difference was found between DLT and VLT (P = 0.453). A burst pressure ≥30 mmHg was achieved in all DLT cases. None of the samples clamped with DLT and VLT exhibited MZS 3-5. The rate of MZS ≥2 with DeBakey 3rd, Fogarty vascular clamp at the second notch (Fogarty 2nd), gold and silver clips, and VLT was statistically comparable to that for DLT, whereas DeBakey vascular clamp at the fourth notch (DeBakey 4th) resulted in significantly higher MZS values than did DLT (P = 0.029).

The DLT is a feasible and safe for thoracoscopic clamping. Additionally, DLT, VLT, and gold clip are appropriate for clamping the peripheral PA. For DeBakey vascular clamp, notch selection should be carefully tailored to the vessel diameter.