Selective Bronchial Arteriography

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Abstract
Carcinoma of the lung is one of the most malignant of all visceral tumors, as well as one of the few in which the vascular bed has not been studied intensively in vivo. This is true not only because of its relatively sparse vascularity, but also because of the technical difficulties of perfusing the bronchial circulation with contrast medium in adequate concentration. The study of these tumors is important from the point of view of differential diagnosis. It is at times impossible to distinguish between inflammatory and neoplastic disease in the lung, short of operative biopsy. Our present angiographic methods of evaluating the extent and operability of lung tumors, pulmonary arteriography and superior vena cavography, are indirect and depend on displacement or direct invasion of vessels. The capacity to define a tumor circulation reliably, and to differentiate it from the vascular patterns in inflammatory disease in the lung, would represent a significant advance in diagnostic medicine. The ability to perfuse the tumor circulation selectively might also open the way toward a more rational chemotherapeutic effort to impede the progress of the neoplasm. The role of the bronchial arteries as the primary nutrient channels of pulmonary tissue has long been of interest. It is known that these vessels may increase strikingly in size in the presence of localized pulmonary disease. The extent to which these alterations have been investigated in man has been limited until recently. Within the past few years, a number of workers have attacked this problem. Williams et al. (10), for example, have employed nonselective thoracic aortography to demonstrate the bronchial arteries in patients with pulmonary disease. Neyazaki (5, 6) has utilized balloon catheters in the thoracic aorta to isolate a segment of the aorta, which is then perfused with contrast medium. In this way, he has been able to demonstrate reverse filling of the pulmonary arteries through bronchial collateral channels in the presence of pulmonary disease. Our own interest has focused on the development and application of a selective technic to the study of the bronchial circulation. The purpose of this preliminary report is to describe the technic, to analyze its feasibility, and to record some of the data thus far obtained from in vivo studies of the bronchial circulation in bronchogenic carcinoma. Anatomic Considerations The most thorough study of the anatomy of the bronchial arteries was performed by Cauldwell and his co-workers (1). They dissected 150 cadavers, identifying both the origin and course of these vessels. For the purpose of selective catheterization, several findings from this study are pertinent. A single bronchial artery occurred on the right in 60 per cent of cases, and on the left in 30 per cent. Two bronchial arteries were on the right in an additional 30 per cent, and on the left in an additional 60 per cent.

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