Die Bronchialarterien – ein kleiner, aber lebenswichtiger Beitrag zur Lungenperfusion nach Lungentransplantation

Zusammenfassung

Die Blutversorgung der Lunge besteht aus dem pulmonal- und dem bronchial-arteriellen System. Die bronchial-arteriellen Gefäße sind an der nutritiven Versorgung der kleinen Atemwege bis hin zu den terminalen Bronchiolen beteiligt. Zudem sind sie bedeutsam für die Regulation der Atemwegstemperatur, der -feuchtigkeit sowie der mukoziliären Clearance. Eine chronische Ischämie der kleinen Atemwege durch Verlust oder Verletzung der bronchial-arteriellen Versorgung erhöht das Risiko für eine Fibrosierung der kleinen Atemwege (obliterative Bronchiolitis), im Speziellen bei einer Lungentransplantation (LTx). Wenngleich sich die Überlebensrate nach LTx im Verlauf verbessert hat, ist sie noch immer deutlich schlechter als bei anderen Organtransplantationen mit einer 5-Jahres-Überlebensrate von 50 bis 60%. Es ist zu vermuten, dass eine bronchial-arterielle Revaskularisierung zum Zeitpunkt der LTx eine wichtige transplantaterhaltende Funktion hat.

Abstract

Blood supply to the lungs is carried out by the pulmonary and bronchial-arterial system. The bronchial-arterial vessels are involved in supplying the small airways all the way up to the terminal bronchioles. The bronchial-arterial system is also necessary for the regulation of airway temperature, humidity and mucociliary clearance. Chronic ischaemia of the small airways due to damage or injury to bronchial arterial supply increases the risk of fibrosis of the small airways (bronchiolitis obliteration), especially in lung transplantation (LTx). Although survival after LTx has improved over time, it is, with a 5-year survival rate of only 50 to 60%, still significantly worse than that of other organ transplants. It is likely that bronchial arterial revascularisation at the time of LTx plays an important transplant-preserving function.

Schlüsselwörter

Bronchialarterie - Ischämie - Lungentransplantation - Revaskularisierung - Bronchiolitis obliterans

Keywords

bronchial artery - ischaemia - lung transplantation - revascularisation - bronchiolitis obliterans

Publication History

Received: 23 March 2022

Accepted after revision: 05 May 2022

Article published online:
25 July 2022

• Literatur

• 1 Deffebach ME, Charan NB, Lakshminarayan S. et al. The Bronchial Circulation. Small, but a Vital Attribute of the Lung. Am Rev Respir Dis 1987; 135: 463-481
• 2 Osiro S, Wear C, Hudson R. et al. A friend to the airways: a review of the emerging clinical importance of the bronchial circulation. Surg Radiol Anat 2012; 34: 791-798
• 3 Walker CM, Rosado-de-Christenson ML, Martinez-Jimenez S. et al. Bronchial Arteries: Anatomy, Function, Hypertrophy, and Anomalies. Radio Graphics 2015; 35: 32-49
• 4 Virchow R. Gesammelte Abhandlungen zur Wissenschaftlichen Medicin. Frankfurt a.M: Verlag von Meidinger Sohn; 1856
• 5 Giese W. Über die Endstrombahn der Lunge. In: Lungen und kleiner Kreislauf. Bad Oeynhäuser Gespräche I,45 (1956). Berlin-Göttingen-Heidelberg: Springer; 1957
• 6 v. Hayek H. Kurz- und Nebenschlüsse des menschlichen Lungenkreislaufs in der Pleura. Z Anat 1942; 112: 221
• 7 Mitzner WA. Leonardo and the Physiology of Respiration. In: Procter DF. A History of Breathing Physiology. Marcel Dekker Inc; New York, Basel, Hong Kong: 1995
• 8 Ruysch F. Epistola Anatomica Probl Sexta. Amsterdam: 1696
• 9 Choi WS, Kim MU, Kim HC. et al. Variations of bronchial artery origin in 600 patients. Systematic analysis with multidetector CT and DSA. Medicine 2021; 100: 22(e26001)
• 10 Cauldwell EW, Siekert RG. et al. The bronchial arteries: an anatomic study of 150 human cadavers. Surg Gynecol Obstet 1948; 86: 394-412
• 11 Crespo MM. Airway complications in lung transplantation. J Thorac Dis 2021; 13: 6717-6724
• 12 Pettersson G, Karam K, Thuita L. et al. Comparative study of bronchial artery revascularization in lung transplantation. J Thorac Cardiovasc Surgery 2013; 146: 894-900
• 13 Tong MZ, Johnston DR, Petterson GB. Bronchial artery revascularization in lung transplantation: revival of an abandoned operation. Curr Opin Organ Transplant 2014; 19: 460-467
• 14 Patterson GA. Airway Revascularization: Is it necessary?. Ann Thorac Surg 1993; 56: 807-808
• 15 Yun JJ, Unai S, Petterson G. Lung transplant with bronchial arterial revascularization: review of surgical technique and clinical outomes. J Thorac Dis 2019; 11: 1821-1828
• 16 Herold U, Jakob H, Kamler M. et al. Interruption of bronchial circulation leads to a severe decrease in peribronchial oxygen tension in standard lung transplantation technique. Eur J Cardio-thoracic Surgery 1998; 13: 176-183
• 17 Nicolls MR, Zamora MR. Bronchial blood supply after lung transplantation without bronchial artery revasculaization. Curr Opin Organ Transplant 2010; 15: 563-567
• 18 Kamler M, Nowak K, Bock M. et al. Bronchial artery revasculaization restores peribronchial tissue oxygenationafter lung transplantation. J of Heart and Lung Transplant 2004; 23: 763-766
• 19 Norgaard MA, Andersen CB, Pettersson G. Does bronchial artery revascularization influence results concerning bronchiolitis obliterans syndrome and/or obliterative bronchiolitis after lung transplantation?. Eur J Cardio-thoracic Surg 1998; 14: 311-318
• 20 Nowak K, Kamler M, Bock M. et al. Bronchial artery revascularization affects graft recovery after lung transplantation. Am J Respir Crit Care Med 2002; 165: 216-220
• 21 Kreisel D, Krupnick AS, Puri V. et al. Short- and long-term outcomes of 1000 adult lung transplant recipients at a single center. J Thorac and Cardiovasc Surg 2011; 141: 215-222
• 22 Wagner ME, Foster WM. Importance of airway bloodflow on particle clearance from the lung. J Appl Physiol 1985; 81: 1878-1883
• 23 Wagner ME, Brown RH. Blood flow distribution within the airway wall. J Appl Physiol 2002; 92: 1964-1969
• 24 Kulkarni HS, Cherikh WS, Chambers DC. et al. Bronchiolitis-obliterans syndrome-free survival following lung transplantation – an International Society for Heart and Lung Transplantation (ISHLT) Thoracic Transplant Registry analysis. J Heart Lung Transplant 2019; 38: 5-16
• 25 Vanstapel A, Verleden SE, Verbeken EK. et al. Beyond Bronchiolitis Obliterans: In Depth Histopathologic Characterization of Bronchiolitis Obliterans Syndrome after Lung Transplantation. J Clin Med 2022; 111: 1-17
• 26 Babu AN, Murakawa T, Thurmann JM. et al. Microvascular destruction identifies murine allografts that cannot be rescued from airway fibrosis. J Clin Invest 2007; 117: 3774-3785
• 27 Dhillon GS, Zamora MR, Roos JE. et al. Lung Transplant Airway Hypoxia. A Diathesis to Fibrosis?. Am J Respir Crit Care Me 2010; 182: 230-236
• 28 Luckraz H, Goddard M, McNeil K. et al. Is obliterative bronchiolitis in lung transplantation associated with microvascular damage to small airways?. Ann Thorac Surg 2006; 82: 1212-1218
• 29 Luckraz H, Goddard M, McNeil K. et al. Microvascular changes in small airways predispose to obliterative bronchiolitis after lung transplantation. J Heart Lung Transplant 2004; 23: 527-531
• 30 Burns KE, Iacono AT. Incidence of clinically unsuspected pulmonary embolism in mechanically ventilated lung transplant recipients. Transplantation 2003; 76: 964-968
• 31 Burns KE, Iacono AT. Pulmonary embolism on postmortem examination: an under-recognized complication in lung-transplant recipients?. Transplantation 2004; 77: 692-698
• 32 Krivokuca I, van de Graaf EA, van Kessel DA. et al. Pilmonary embolism and pulmonary infarction after lung transplantation. Thrombosis/Hemostasis 2011; 17: 421-424
• 33 Kristensen AW, Mortensen J, Berg RM. Pulmonary thromboembolism as a complication of lung transplantation. Clinical Transplantation 2017; 31: e12922
• 34 Bordt J, Müller KM. Lungendurchblutung bei Lungenarterienembolien ohne Lungeninfarkt. Fortschr Röntgenstr 1977; 126: 87-89
• 35 Kaptain FHJ, Kroft LJM, Hammerschlag G. et al. Pulmonary infarction in acute pulmonary embolism. Thrombosis Research 2021; 202: 162-169