A Surgical Case of Bronchial Artery Aneurysm Directory Connecting with Pulmonary Artery

We present a surgical case of bronchial artery aneurysm (BAA) connecting pulmonary artery accompanied with racemose hemangioma. This is a third surgical case report of BAA directly connecting pulmonary artery in the English literature. A 63-year-old female was found a BAA, 2 cm in diameter, connecting right A4 pulmonary artery. The patient underwent two attempts for embolization. However, due to extensive collaterals, there was persistent flow in the aneurysm. Standard lateral thoracotomy was performed. A BAA was located between A4 and A5 PA. A small branch of A4 PA was separated, and the small vessel connecting to the BAA could be ligated. A5 PA was separated similarly, however BAA was ruptured not to identify the other small vessel connecting to the BAA. After a clamp of the BAA, middle lobe lobectomy was performed. We removed the aneurysm with dilated bronchial artery connecting to the aneurysm. The postoperative course was uneventful.     

A Surgical Case of Bronchial Artery Aneurysm Connecting to a Pulmonary Artery and Vein Complicated by Racemose Hemangioma

We report a surgical case of bronchial artery aneurysm (BAA) that directly connected to a pulmonary artery and a pulmonary vein through an abnormal vessel. It was complicated by racemose hemangioma. This is a rare vascular malformation. An 82-year-old female had a large BAA that was found incidentally. First, we consider treating the BAA with embolization by interventional radiology (IVR). However, because of strong meandering of the bronchial artery, we could not advance a microcatheter into the BAA. Therefore, a surgical operation was performed through a standard posterior lateral thoracotomy. The BAA was located between the upper and lower lobes and directly connected to the pulmonary artery. Some bronchial artery branches that provided inflow to the aneurysm were ligated, and the abnormal vessel that connected the BAA to the upper pulmonary vein was ligated easily. A fistula between the BAA and pulmonary artery was sutured by the cardiovascular surgeon using an artificial cardiopulmonary device, with permissive stenosis of A2b (ascending A2).     

Massive Hemoptysis: Control by Transcatheter Bronchial Artery Embolization

Massive hemoptysis (600 ml in 48 hours) has an ominous prognosis with a mortality of 50 to 100% in medically treated patients and up to 35% in patients undergoing operation. Surgical resection has been the procedure of choice in patients with massive hemoptysis. Those with a contraindication to operation present a particularly frustrating problem. We have treated 7 such patients with massive hemoptysis by transcatheter bronchial artery embolization. In all 7, the bleeding was arrested. Two patients died of recurrent hemoptysis, 1 ten days and the other 2 months following embolization, and 5 are well 1 month to one year later. Transcatheter bronchial artery embolization is a valuable therapeutic modality in patients with massive hemoptysis. However, the procedure is palliative, and, therefore, elective resection must be considered as definitive treatment in those patients who have no contraindication to operation.     

Bronchial fistula postpneumonectomy: predictive factors

OBJECTIVE: To determine predictive factors of bronchial fistula following pneumonectomy. PATIENTS AND METHODS: In 14 years (1989-2003), we collect 58 cases of bronchial fistula following 725 consecutive pneumonectomy in the service of thoracic surgery of the Sainte Marguerite Hospital in Marseilles. There were 53 cases (91.4%) of cancers and 5 cases (8.6%) of various pathology. The average age of the patients was of 61 +/- 10 years (range 24 to 80 years). The sex ratio M/F was 8.7. The software of regression SPSS (version11.5) was used to identify the factors risk of a bronchial fistula after a univariate and multivariate analysis. RESULTS: The prevalence of the bronchial fistula after a pneumonectomy was 8%.The preoperative factors which increased to a significant degree the incidence of the bronchial dent to the univariate analysis were the chronic smoking (P < 0.001), the existence of COPD (P = 0.001) and of a previous thoracic surgery (P = 0.01). Operational data like a right- side pulmonary resection (P < 0.001), the type of bronchial stup carried out (P = 0.03) as and an extended pneumonectomy to the auricule (P = 0.03) were significant risk factors. With the logistic regression the significant risk factors were the chronic smoking (P = 0.002), the existence of COPD (P = 0.003), a previous pulmonary surgery (P = 0.03) and the right - side of the pneumonectomy (P < 0.001). The indication of the pneumonectomy was retained neither by the univariate analysis, nor by the logistic regression significant risk factors. CONCLUSION: The predictive factors of a bronchial fistula after a pneumonectomy are dominated by respiratory co-morbidities. To prevent this complication, we insist on the stop of the tobacco, a better respiratory preparation and the acquisition of a protocol adapted of the bronchial stub after a pneumonectomy particularly on the right side.     

Magnetic Resonance Imaging Angiography in Patency Evaluation of Bronchial Artery Revascularization Grafts

In this report we present our experience of non-invasive magnetic resonance imaging (MR) angiography and selective catheter angiography in assessing the patency of bronchial artery revascularization grafts after an en bloc double-lung and heart-lung transplantation. We studied 8 patients who had undergone pulmonary transplantation with direct bronchial artery revascularization. Catheter angiography was performed 10 days to 63 months postoperatively. MR angiography was performed within 24 h of the catheter procedure and the results were compared with the findings from catheter angiography. Catheter angiography showed the bronchial revascularization graft to be patent in 6 patients and occluded in 2. At MR angiography, the patency of bronchial artery revascularization grafts was reliably identified in 7 of the 8 patients. One patient had inadequate image quality because of void artefacts caused by haemostatic clips. It is concluded that MR angiography is a reliable method for assessing the patency of bronchial artery revascularization grafts.     

胸腔镜辅助小切口肺血管-支气管成形术治疗中央型肺癌139例分析

目的探讨胸腔镜辅助小切口和常规后外侧切口在肺血管-支气管成形术治疗中央型肺癌中的可行性及效果。方法对广州医学院第一附属医院1995年1月至2007年7月139例采用胸腔镜辅助小切口术式及四川大学华西医院2000年4月至2005年12月99例采用常规后外侧切口术式的因病变涉及肺叶开口或肺动脉,而行肺血管-支气管成形术患者的临床资料进行回顾性分析。结果两组患者均顺利完成手术,无围手术期死亡,术后无吻合口狭窄、吻合口瘘及切缘癌细胞残留。胸腔镜辅助小切口组平均生存时间为63．17个月,常规后外侧切口组为42．00个月,术后生存率无明显差异。肺动脉成形患者的保留肺叶无肺再灌注损伤或明显肺水肿征象。胸腔镜辅助小切口组辅助切口的平均长度为10cm,常规后外侧切口组切口平均长度为30cm。胸腔镜辅助小切口组手术时间、术后胸管留置时间及住院时间均短于常规后外侧切口组,术后患侧肩关节功能障碍发生率低。结论利用胸腔镜辅助小切口施行肺血管一支气管成形术,不仅具有与常规后外侧切口相同的适应证和术后生存率,而且在减小手术创伤,促进患者恢复方面具有优势。     

急诊经导管支气管动脉栓塞术治疗支气管动脉-肺动脉瘘大咯血

目的探讨急诊经导管支气管动脉栓塞(BAE)治疗支气管动脉-肺动脉瘘大咯血的疗效。方法回顾性分析17例支气管动脉-肺动脉瘘大咯血患者动脉造影表现及急诊BAE的疗效。经急诊动脉造影明确出血部位后,采用聚乙烯醇(PVA)颗粒和明胶海绵条对出血动脉行BAE;术后评价疗效、并发症及咯血复发情况。结果 17例中共发现29支病变支气管动脉,成功予以栓塞。BAE术后16例24h内完全停止咯血,1例于术后2天完全停止咯血。5例于BAE后接受外科手术,切除原发病灶。BAE后未发生严重并发症,随访2年,咯血均无复发。结论急诊BAE治疗支气管动脉-肺动脉瘘大咯血安全、有效。     

Comparison of Two Automatic Staplers for Closing the Bronchial Stump after Pulmonary Resection

The incidence of complications following pulmonary resection using an automatic stapler was studied in 348 consecutive patients. A parallel-jaw stapler with two staple lines was used in group A (133 males, 101 females, mean age 66 years) between 1990 and 1995, and a hinged-jaw stapler with three staple lines in group B (70 males, 44 females, mean age 67 years) in 1995-1997. The incidence of bronchopleural fistula was 0.4% (1 patient) in group A and nil in group B. The incidence of intraoperative air leak requiring interrupted suture closure was 4.7% (11 patients) in group A and nil in group B (p &lt; 0.05). Postoperative bronchopleural fistula did not develop in any of the cases, and there was no mortality. For management of the bronchial stump after pulmonary resection, the newer device firing three rows of staples is superior to the two-row device.     

双血供CT灌注用于肺部疾病研究进展

双血供CT灌注(DI-CTP)可同时定量评估肺动脉(PA)和支气管动脉(BA)供血,显示病理状态下二者供血比例变化,提供肺部病灶形态学和血流动力学信息,有助于鉴别良、恶性病变。本文就DI-CTP用于肺部疾病研究进展进行综述。     

Pulmonary hypertension and the possibilities of its radiographically guided endovascular correction in chronic nonspecific lung diseases]

Bronchial arteriography and catheterization of the pulmonary artery (PA) were applied in the examination of 120 patients with chronic nonspecific diseases of the lungs. The specific features of bronchopulmonary blood circulation in various pathological processes were revealed. Pulmonary hypertension (PH) was encountered in 71.5% of cases, and pressure in the PA was significantly higher in the group of patients with massive bronchopulmonary blood shunting (chronic pulmonary suppurations) than in the group of patients with minimal blood shunting (nonsuppurative processes). Radiologically-guided endovascular correction of the disorders of the bronchopulmonary blood flow was conducted in 85 patients by occlusion of the bronchial arteries (BA). Pressure in the PA significantly reduced after the correction due to diminished left-to-right blood shunting. Thus, besides the generally known mechanisms, bronchopulmonary shunting of blood plays a certain role in the pathogenesis of PH in chronic suppurative processes. Endovascular BA occlusion for correction of PH in patients with bilateral lesions is expedient.     

综合护理在镍钛合金支气管封堵器治疗支气管瘘患者中的应用效果

目的 探讨综合护理在镍钛合金支气管封堵器治疗支气管瘘患者中的应用效果。方法 选取本院 2021年1月-9月收治的21例支气管瘘患者为研究对象,按照不同护理方法分为对照组10例与观察组11例。 对照组予以常规护理,观察组予以综合护理,比较两组心理状况、满意度、生活质量及不良反应发生情 况。结果 观察组护理后SAS和SDS评分均低于对照组,差异有统计学意义（P＜0.05）;观察组满意度高于 对照组,差异有统计学意义（P＜0.05）;观察组生理功能、生理职能、躯体疼痛、总体健康、生命活力及 社会功能评分高于对照组,差异有统计学意义（P＜0.05）;随访1年,所有患者因支气管瘘引起的咳嗽、 咳痰、感染症状基本消失,封堵器定位准确。结论 对镍钛合金支气管封堵器治疗支气管瘘患者实施综合 护理有助于提高护理满意度,改善患者不良情绪,提高生活质量,值得临床应用。     

Bronchial stump reinforcement with the intercostal muscle flap without adverse effects.

OBJECTIVE: Bronchopleural fistula is a serious complication of pulmonary resection. For anatomical reasons, lower lobectomy is thought to carry a higher risk for bronchopleural fistula. We investigated the efficacy of bronchial stump reinforcement with a pedicled intercostal muscle flap after lower lobectomy and compared the responses in patients treated with the flap, without the flap, and with other types of flap. We also investigated whether harvesting the intercostal muscle flap leads to an increase in blood loss during surgery and whether the type of flap influences chest-tube volume and pain after surgery. METHODS: One hundred and sixty-eight patients had lower or middle-lower lobectomy between January 1990 and December 2004. The bronchial stumps were treated in one of the three ways: covered with an intercostal muscle flap (116 patients, group A), not covered with a muscle flap (32 patients, group B), or covered with free fat or pleura (20 patients, group C). In a separate study, we compared the blood loss during surgery, and chest-tube volume and pain after surgery between patients treated with the intercostal muscle flap (23 patients) and non-intercostal muscle flap (32 patients). Results: No patients in group A exhibited bronchopleural fistula, and two patients in group B and one patient in group C exhibited bronchopleural fistula. These differences were not significant. Blood loss, chest-tube volume, and pain score after surgery did not differ significantly between treatment groups. Conclusions: Bronchial stump reinforcement with the intercostal muscle flap after pulmonary resection is safe and effective when performed during lower and lower-middle lobectomy and does not increase the risk of complications.     

Healing of Bronchial Allografts in Pigs

Our purpose was to investigate the healing of bronchial grafts in a porcine experimental model. Via left thoracotomy, a 2.5 cm long bronchial stump was anastomosed back to the same animal (autograft) or to another pig (allograft). Autotransplanted bronchi (six pigs) healed very well without infection. Allotransplantation without immunosuppression (eight pigs) was followed in all cases by rejection with formation of major bronchopleural fistula. After allotransplantation with triple-drug immunosuppressive medication (seven pigs), three pigs showed infection-free healing, but the anastomoses were slightly stenosed at the time of sacrifice (mean 30 d), while four had bronchopleural fistula. The study thus showed the healing ability of totally avascular bronchial graft in pigs to be very good when it is autotransplanted, but poor when allotransplanted without immunosuppressive treatment.     

Bronchoplastic procedures and pulmonary artery reconstruction in the treatment of bronchogenic cancer

Nineteen patients with primary bronchogenic carcinoma underwent bronchoplastic procedures (six wedge and 13 sleeve resections) between 1970 and 1982. In six of them lobectomy was combined with sleeve resection and reconstruction of the pulmonary artery: In one a synthetic prosthesis was inserted. Twelve patients had squamous cell carcinoma, five adenocarcinoma, and two large cell carcinoma. No operative deaths were observed, and the 5 year survival rate is 28.1%. One patient had an early bronchial fistula and two patients had bronchial stenosis (one suture granulation and one local recurrence). No patient with resection of the pulmonary artery had vascular complications. Survival rates on the basis of nodal involvement indicate 50% survival at 5 years without nodal metastasis (11 cases) versus 9.7% with nodal involvement (eight cases) (p less than 0.05). Bronchoplastic procedures, even if accompanied by segmental resection of the pulmonary artery, can be performed safely with long-term results comparable to those following major pulmonary resections.     

Bronchial arteriovenous malformation with large aneurysm,resected by video-assisted thoracic surgery

Bronchial arteriovenous malformation with a large aneurysm appearing as a mass shadow in the right hilum on chest imaging was successfully extirpated thoracoscopically without any lung resection. Preoperative angiography showed tortuous, enlarged right bronchial arteries with an aneurysm connecting to the pulmonary artery, which could not be totally embolized via the transcatheter approach because of the length of the abnormal bronchial artery and possibility of embolotherapy-induced pulmonary infarction. Histological examination revealed defects of the media and internal elastic lamina of the resected bronchial arteries and aneurysm. The patient was free of hemoptysis and other airway symptoms 4 years after surgery.     

Bronchial artery embolization for treatment of mediastinal hemorrhage after pulmonary resection: report of a case

We report a rare case of mediastinal hemorrhage after pulmonary resection. A 64-year-old woman with hypersensitivity pneumonitis was diagnosed as adenocarcinoma of the lung by bronchoscopical examination. Left lower lobectomy and mediastinal lymph node dissection were performed. Sudden chest pain and dry cough developed 14 days after the operation. Her diastolic pressure rose transiently but electrocardiogram remained normal. Chest X-ray showed widening of the mediastinum and enhanced chest computed tomography (CT) showed extravasation of the contrast media just under the bifurcation of the trachea. Multi projection volume reconstruction revealed mediastinal hemorrhage from the bronchial artery. The chest pain disappeared after a successful bronchial artery embolization and the patient discharged 21 days later. Hemorrhage after pulmonary resection is a common complication, but no previous report has described mediastinal hemorrhage occurring 2 weeks after the operation. In a similar case, bronchial artery embolization is a reliable and minimally invasive therapy for mediastinal hemorrhage.     

Reoperation for left main bronchial stump fistula developing after pneumonectomy

We report the case of a 71-year-old male patient who underwent reoperation for bronchial stump fistula developing after left pneumonectomy for adenocarcinoma of the left lung (clinical stage IIB). After surgery, he developed persistent, severe cough and chest X-ray films taken on the 23rd postoperative day showed a drop in the air-fluid level in the left lung field, which, along with bronchoscopic findings, strongly suggested the bronchial stump fistula and subsequent reoperation was performed. Both superior pulmonary vein and main pulmonary artery were dissected again proximally in pericardium, and the left main bronchus was separated from the surrounding tissue. Bronchial stump was closed with a stapler as close to the carina as possible, and additional resection was performed. After reoperation, the patient had an uneventful course, and was discharged in the second postoperative week. Shorter length of bronchial stump may be the most important factor to prevent the bronchial stump fistula developing after pneumonectomy.     

Bronchial obstruction due to Teflon pledgets migration 13 years after lobectomy

Bronchopleural fistula is a major cause of morbidity and mortality after pulmonary resection. Different techniques of reinforcing the bronchial stump to prevent this complication have been described. Pledgeted sutures have been suggested for this purpose but have the potential to erode into the bronchus years after resection. We report an unusual case of airway obstruction 13 years after lung resection where pledgeted sutures had been used to reinforce a lobectomy stump. Bronchoscopic management of this rare complication consisted of endobronchial débridement and placement of a silicon stent to allow remodeling of the stenotic airway.     

Bronchial artery aneurysm treated with aortic stent graft and fibrin sealant

Bronchial artery aneurysm occurs rarely but can cause a life-threatening hemorrhage when it ruptures. The traditional therapy has been aneurysm resection or transcatheter arterial embolization. We report a case of mediastinal bronchial artery aneurysm which could not be occluded with transcatheter arterial embolization and instead was treated with a thoracic aortic stent graft and embolization with fibrin sealant.