Comparison of imaging changes in pulmonary artery diameter at the occlusion site using silk or metal clamps for pulmonary artery troubles

Abstract

Objectives: We analysed our clinical experience using silk sutures [the double-loop technique (DLT)] or DeBakey type vascular clamp (DeBakey clamp) for pulmonary artery (PA) troubles during anatomical lung resection to validate its practicality and safety.

Methods: We retrospectively reviewed the records of patients who underwent either of the above clamping techniques during anatomical lung resection at our hospital between April 2007 and August 2022. We measured the PA diameter at the occlusion site on computed tomography images acquired within 1 year pre- and postoperatively. The difference between pre- and postoperative diameters of the occlusion sites was calculated as the change in the PA diameter. We zoned the occlusion site of the PA to adjust for variation. PA deformation was evaluated as an adverse event caused by clamping.

Results: Ultimately, 27 and 26 patients who underwent the DLT and DeBakey clamp, respectively, were included. No additional injury due to the clamp procedure was found in either group. For zone R1/L1, defined as the main PA, the median changes in the PA diameter were 0.02 (-0.7 to 0.27) mm for the DLT and 0.36 (-0.28 to 0.89) mm for the DeBakey clamp. No significant differences were observed between the 2 groups (P = 0.106). Furthermore, no aneurysms, dissections, or stenoses were found in either group.

Conclusions: The DLT and DeBakey clamp had only minimal effects on the occlusion site of the PA. The DLT is a practical thoracoscopic technique for PA bleeding when primary haemostasis has been achieved.

Keywords: Anatomical lung resection; DeBakey type vascular clamp; Double-loop technique; Minimally invasive surgery; Pulmonary artery troubles; Video-assisted thoracoscopic surgery.

Figure 1:

Zone for clamping to pulmonary artery. A: artery; PA: pulmonary artery.

Figure 2:

Patient flow chart. CT: computed tomography; DLT: double-loop technique; PA: pulmonary artery; VATS: video-assisted thoracoscopic surgery.

Figure 3:

Comparison of the change in the pulmonary artery diameter at the occlusion site between the DLT and DeBakey clamp. (A) All zones. (B) Zone R1/L1. DLT: double-loop technique. Wilcoxon signed-rank test.