Pulmonary artery reconstruction using a pulmonary vein conduit in case having an imbalanced dissection length during double-sleeve lobectomy

Abstract

BackgroundAmong the types of lung resection procedures, pneumonectomy carries the highest risk for mortality. In recent years, bronchovascular double-sleeve lobectomy has been performed for centrally located non-small cell lung cancer involving both the bronchus and the pulmonary artery (PA) in order to avoid pneumonectomy. The use of an autologous pulmonary vein (PV) conduit for PA reconstruction during lung-sparing resections had first been reported in 2009. Such situations may occur in cases requiring the resection of a long segment of the PA without associated bronchial sleeve resection.Case presentationWe experienced two cases who underwent PA reconstruction using a PV conduit after double-sleeve resection. In both cases, the tumor was located in the left upper lobe and invaded the long segment of the PA; however, it had not significantly invaded the bronchus. Our strategy for bronchovascular reconstruction involved the use of a PV conduit to avoid high tension on direct anastomosis given the imbalance in the excision length between the PA and the bronchus. The intraoperative and postoperative courses were uneventful, with both cases not receiving anticoagulant agents during the postoperative period. The reconstructed bronchus and PA functioned well during postoperative follow-up visits.ConclusionsFollowing sleeve resection, an autologous PV conduit may be indicated for PA reconstruction when an excessive distance exists between the two vascular stumps.