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Ann Thorac Surg 2001;72:1441
© 2001 The Society of Thoracic Surgeons

Correspondence

Embolization of anomalous systemic lobar artery: Reply

Akira Yamanaka, MDa, Takashi Hirai, MDa

a Department of Chest Surgery, Fukui Red Cross Hospital, 2-4-1 Tsukimi, Fukui 918-8501, Japan

e-mail: akiray{at}mitene.or.jp

To the Editor

We thank Dr Brühlmann for suggesting embolotherapy as a less invasive alternative treatment. There are several surgical procedures available for this rare disease depending on the clinical features. Regarding the pathology, there is an incomplete type with a dual (systemic and pulmonary artery) blood supply to the affected segments [1]. We agree that ligation of the anomalous arteries can be done only in patients with a normal pulmonary artery blood supply. In general, we also agree that embolotherapy can be recommended as a less invasive therapy for such patients.

We suggest two points to keep in mind when embolotherapy is being considered: the risk of a small therapeutic embolus escaping to the left circulation in patients with arteriovenous malformation [2] and the need of angiography from the descending thoracic aorta through the abdominal aorta. Anomalous arteries tend to arise from the abdominal aorta in patients with a dual arterial blood supply, and two or more anomalous arteries can coexist [1].

As less invasive surgical therapy, ligation or severance of the anomalous arteries can be achieved only with VATS (video-assisted thoracoscopic surgery). If embolotherapy produces incomplete occlusion or if arterialization recurs despite embolotherapy, VATS can still be applied.

References

  1. Yamanaka A., Hirai T., Fujimoto T., Hase M., Noguchi M., Konishi F. Anomalous systemic arterial supply to normal basal segments of the left lower lobe. Ann Thorac Surg 1999;68:332-338.[Abstract/Free Full Text]
  2. Currarino G., Willis K., Miller W. Congenital fistula between an aberrant systemic artery and a pulmonary vein without sequestration. A report of three cases. J Pediatr 1975;87:554-557.[Medline]




This Article
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Takashi Hirai
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