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Reconstruction of the Pulmonary Artery

Erino A. Rendina, Federico Venuta
Reconstruction of the Pulmonary Artery is a topic covered in the Pearson's General Thoracic.

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Key Points

  • Oncologically complete resection should be primarily pursued.
  • Use of magnifying loops (2.5×) is essential.
  • Do not insist on wedge resection or patch reconstruction when a sleeve with end-to-end anastomosis can ensure a larger caliber and a straight arterial axis.
  • High-tension anastomosis must be avoided, do not hesitate to interpose a conduit.
  • Choose the most appropriate biologic material when prosthetic reconstruction is required.
  • Test the arterial axis and suture oozing after reinflation of the residual lobe; torsion of the arterial axis may cause oozing or torsion of the artery.

The pulmonary artery (PA) can be infiltrated by primary lung tumors or by metastatic hilar-mediastinal lymph nodes with extracapsular extension. The right and left PAs can be involved to various extents. Partial infiltration of the arterial wall may be limited and require only simple, tangential resection and direct suture. This technique is regarded as a variation of standard lobectomy and is not considered in this chapter.

More extensive defects of the PA (Table 1) may require reconstruction by a patch (of various materials), sleeve resection and reconstruction by end-to-end anastomosis, or sleeve resection and reconstruction by a prosthetic conduit. If the main PA is infiltrated by advanced lung cancer, the reconstruction requires the use of cardiopulmonary bypass.

Table 1: Techniques of Reconstruction of the Pulmonary Artery

Partial infiltration

Patch reconstruction

Autologous pericardium

Bovine pericardium

Azygos vein

Superior pulmonary vein

Synthetic

Complete circumferential infiltration

Pulmonary artery sleeve

End-to-end anastomosis

Pericardial conduit Prosthesis

Autologous superior pulmonary vein conduit

Infiltration of main pulmonary artery

Reconstruction via cardiopulmonary bypass

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Key Points

  • Oncologically complete resection should be primarily pursued.
  • Use of magnifying loops (2.5×) is essential.
  • Do not insist on wedge resection or patch reconstruction when a sleeve with end-to-end anastomosis can ensure a larger caliber and a straight arterial axis.
  • High-tension anastomosis must be avoided, do not hesitate to interpose a conduit.
  • Choose the most appropriate biologic material when prosthetic reconstruction is required.
  • Test the arterial axis and suture oozing after reinflation of the residual lobe; torsion of the arterial axis may cause oozing or torsion of the artery.

The pulmonary artery (PA) can be infiltrated by primary lung tumors or by metastatic hilar-mediastinal lymph nodes with extracapsular extension. The right and left PAs can be involved to various extents. Partial infiltration of the arterial wall may be limited and require only simple, tangential resection and direct suture. This technique is regarded as a variation of standard lobectomy and is not considered in this chapter.

More extensive defects of the PA (Table 1) may require reconstruction by a patch (of various materials), sleeve resection and reconstruction by end-to-end anastomosis, or sleeve resection and reconstruction by a prosthetic conduit. If the main PA is infiltrated by advanced lung cancer, the reconstruction requires the use of cardiopulmonary bypass.

Table 1: Techniques of Reconstruction of the Pulmonary Artery

Partial infiltration

Patch reconstruction

Autologous pericardium

Bovine pericardium

Azygos vein

Superior pulmonary vein

Synthetic

Complete circumferential infiltration

Pulmonary artery sleeve

End-to-end anastomosis

Pericardial conduit Prosthesis

Autologous superior pulmonary vein conduit

Infiltration of main pulmonary artery

Reconstruction via cardiopulmonary bypass

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Last updated: December 6, 2020