Analysis of bronchovascular patterns in the left superior division segment to explore the relationship between the descending bronchus and the artery crossing intersegmental planes.

BACKGROUND

A comprehensive understanding of the anatomical variations in the pulmonary bronchi and arteries is particularly essential to the implementation of safe and precise left superior division segment (LSDS) segmentectomy. However, no report shows the relationship between the descending bronchus and the artery crossing intersegmental planes. Thus, the purpose of the present study was to analyze the branching pattern of the pulmonary artery and bronchus in LSDS using three-dimensional computed tomography bronchography and angiography (3D-CTBA) and to explore the associated pulmonary anatomical features of the artery crossing intersegmental planes.

MATERIALS AND METHODS

The 3D-CTBA images of 540 cases were retrospectively analyzed. We reviewed the anatomical variations of the LSDS bronchus and artery and assorted them according to different classifications.

RESULTS

Among all 540 cases of 3D-CTBA, there were 16 cases (44.4%) with lateral subsegmental artery crossing intersegmental planes (AXa), 20 cases (55.6%) Without AXa in the descending Ba or B type, and 53 cases (10.5%) with AXa, 451 cases (89.5%) Without AXa in the Without the descending Ba or B type. This illustrated that the AXa was more common in the descending Ba or B type (P < 0.005). Similarly, there were 69 cases (36.1%) with horizontal subsegmental artery crossing intersegmental planes (AXc), 122 cases (63.9%) Without AXc in the descending Bc type, and 33 cases (9.5%) with AXc, 316 cases (90.5%) Without AXc in the Without the descending Bc type. Combinations of the branching patterns of the AXc and the descending Bc type were significantly dependent (p < 0.005). The combinations of the branching patterns of the AXc and the descending Bc type were frequently observed.

CONCLUSIONS

This is the first report to explore the relationship between the descending bronchus and the artery crossing intersegmental planes. In patients with the descending Ba or B type, the incidence of the AXa was increased. Similarly, the incidence of the AXc was increased in patients with the descending Bc type. These findings should be carefully identified when performing an accurate LSDS segmentectomy.