Anatomic study of the bronchial arteries with special reference to their preservation during the radical dissection of the upper mediastinum lymph nodes.

BACKGROUND: The anatomy of the bronchial arteries was studied, with special reference to their preservation during the radical dissection of the upper mediastinum lymph nodes.
METHODS: The bronchial arteries of 71 cadavers were studied macroscopically by use of the surgical field of right thoracotomy. The small branches difficult to identify macroscopically were described by x-ray imaging with digital subtraction angiography. Their anatomic relationship to the adjacent organs was observed microscopically.
RESULTS: The bronchial arteries arising from the intercostal arteries (the intercostobronchial arteries) were observed in 66 of 71 cases. By use of the surgical field of right thoracotomy the intercostobronchial arteries were easily found and preserved. All cadavers also had other bronchial arteries arising from the aorta. These were difficult to preserve because of the depth of the surgical field and the location of their course in the dissected area. Bronchial arteries had established connection with each other via the vascular network in the tracheal proper sheath. India ink injected into the intercostobronchial arteries was observed in the tracheal proper sheath and the submucosa of the trachea.
CONCLUSIONS: Saving the blood supply to the trachea is possible with careful preservation of the intercostobronchial arteries and the tracheal proper sheath during radical dissection of the upper mediastinum.