SELECTIVE BRONCHIAL ARTERIOGRAPHY.

Abstract

The systemic circulation of the lungs may be examined in great detail by percutaneous selective bronchial arteriography. As in angiography of other organs, vascular opacification is improved if the contrast medium is injected selectively into the vascular bed under study. Previous authors (9, 14, 16, 19, 21) have produced opacification of the bronchial arteries by nonselective thoracic aortography. Although on aortography the bronchial arteries may be opacified, detailed analysis of the smaller branches is not possible. Selective bronchial arteriography permits excellent visualization of these vessels, in which the normal anatomy as well as the pathologic changes can be studied (10, 20). Physiologic changes affecting the bronchial circulation may also be studied after selective catheterization of a bronchial artery. In addition, selective chemotherapeutic perfusion of pulmonary neoplasms may be possible with this method of catheterization. Anatomy of the Bronchial Arteries The anatomy of the bronchial arterial circulation has been described previously (2, 5, 15). Normally, the bronchial arteries are small branches arising from the aorta. They supply the bronchi, visceral pleura, walls of pulmonary vessels, and interstitial supporting structures. The middle third of the esophagus, the hilar lymph nodes, vagus nerve, and mediastinal fascia are also nourished by bronchial circulation. Anastomosis with other systemic arteries may occur. Cauldwell et al. (2), on the basis of dissection of 150 cadavers, described 9 variations in the origin of the bronchial arteries. The 4 most common variations are outlined in Figure 1. The site of origin of the right bronchial artery differed from that of the left . Cauldwell and his associates found that the right bronchial artery usually arose from the lateral or posterolateral aspect of the aorta in common with an intercostal artery. The left bronchial arteries usually arose directly from the anterior surface of the aorta, but occasionally from the right side of the aorta in common with a right bronchial artery. In 74 per cent of the dissections the right and left bronchial arteries arose independently, while in the remainder a common trunk divided into right and left bronchial arteries. Rarely, the bronchial artery originated from the subclavian (Fig. 2). The bronchial arteries usually form an acute angle with the aorta at their origin, coursing upward and anteriorly initially. As they extend peripherally, they first lie posterior to the main bronchus and later pass around its lateral aspect to reach an anterior position. The vessels end in an arterial plexus which anastomoses with the pulmonary capill ary plexus. Method The method of selective bronchial arteriography employed by us was initially described by Olin (18) . A green Ödman catheter is tapered to accommodate a wire guide whose outer diameter is 0.025 inches. The end of the catheter is formed into a double curve (Fig. 3).