Variations of lobar branches of pulmonary arteries in thoracic surgery patients

Abstract

The vascular anatomy of the lung and possible variations of the pulmonary artery should be well known by surgeon to prevent complications. The various branching pattern of the pulmonary arteries should be determined to prevent excessive and unnecessary resection with life-threatening bleeding.

Thoracic surgery Anatomic variations of pulmonary vessels relevant with regard to lung tissue resections – literature review and personal experiences

“…A common arterial trunk leading to segment 7L and to the segments of the middle lobe (4R and 5R) has also been described [4]. The doubling of the branch leading to segment 6R is reported with the frequency varying from 6.97% to 12.5% [2,4]. In approximately 33% of cases, it is reported that the distance between the last branch leading to the superior lobe and the trunk or branches running to the middle lobe may amount to 20 mm.…”

“…Multiple branches (two or three) running to the middle lobe may be present in as many as 50% of patients [2]. A common arterial trunk leading to segment 7L and to the segments of the middle lobe (4R and 5R) has also been described [4]. The doubling of the branch leading to segment 6R is reported with the frequency varying from 6.97% to 12.5% [2,4].…”

“…Calculating the frequency of variations that can potentially be dangerous is challenging, as the available literature lacks relevant data. In their work, Sivrikoz and Tulay noted variations of the arterial system during 6/55 right-sided lobectomies and 4/30 left-sided lobectomies [4]. The progress of a procedure burdened with increased anatomical risk depends on Tab.…”

“…The anatomic variations of the arterial system described in surgical reports in the order of frequency. The number of observed cases is provided in brackets Two separate A2R branches [17] Two arteries running to the middle lobe [8] Two arteries running to the lingular segments (4L and 5L) [5] Common branching point for A2R and A6R [4] Two A6L branches [4] Separate branching point for A1R and A3R [3] Common A1+A2+A3 trunk from the right pulmonary artery [3] Three branches to segment 2R [2] Branch A6R from the A4+A5 trunk [1] Additional A3R branch branching off in the fissure [1] Branch A7R from the A4+A5 trunk [1] Separate A1R branch and A2+A3R trunk [1] Common trunk A1+A2+A3 from the left pulmonary artery [1] Four branches running to segments 1,2,3L [1] Very low branching point of A2L [1] The short trunk running to the lingula divided into 3 branches [1] Very low branching point of the trunk running to the lingula [1] Right common arterial trunk divided into 3 branches [1] THORACIC SURGERY the competence and experience of the surgeon. Table III presents the most important variations from this group.…”

“…A common "low" branching point of the arteries running to segments 2R and 6R (Fig. 3A) from the interlobar artery segment can also be problematic; the estimated frequency of its occurrence is varied, ranging from 1.53% to as much as 12% [2,4]. Multiple branches (two or three) running to the middle lobe may be present in as many as 50% of patients [2].…”