The complex anatomy of the bronchial arteries: a meta-analysis with potential implications for thoracic surgery and hemoptysis treatment

Abstract

The present meta-analysis aimed to provide the most detailed and comprehensive anatomical description of bronchial arteries (BAs) using data available in the literature. Adequate knowledge of the normal anatomy and morphological variations of BAs can be clinically significant; for example, this approach can prevent potential risks while undertaking bronchial artery embolization (BAE) procedures and, ultimately, lead to better patient outcomes. Major medical databases such as PubMed, Scopus, Embase, Web of Science, Google Scholar, and the Cochrane Library were searched. The overall search process was conducted in three main stages. The number of BAs varied from one to six, and 16 arterial patterns were observed. The most common variation was in one right BA and one left BA, with a pooled prevalence of 19.54% (95% CI 6.69-36.44%). The pooled prevalence of BAs originating separately from the aorta was 41.42% (95% CI 37.42-45.48%). The number and location of BAs are highly inconsistent. However, the most prevalent pattern involved two BAs: one in the right BA and one in the left BA. Although BAs most frequently originate from the descending aorta, the cooccurrence of at least one ectopic BA is relatively high. The results of our meta-analysis can serve as a source of comprehensive information for thoracic surgeons and physicians performing endovascular procedures, especially BAE, a treatment for life-threatening hemoptysis.

Keywords: Anatomical variations; Bronchial artery; Bronchial artery embolization; Bronchial branches; Hemoptysis.

Fig. 1

Flow diagram presenting the process of collecting the data included in this meta-analysis.

Fig. 2

Scheme presenting the five most common variations in the arrangement and number of bronchial arteries established in this meta-analysis. RBA right bronchial artery, LBA Left bronchial artery, DA descending aorta, BCT Brachiocephalic trunk, RSA right subclavian artery, RCCA right common carotid artery, LCCA Left common carotid artery, LSA Left subclavian artery.

Fig. 3

Scheme presenting the variations in the origin of bronchial arteries. BA Bronchial artery, ICBT intercostal-bronchial trunk, CTB common trunk for both bronchial arteries, ICA intercostal artery, DA descending aorta, BCT Brachiocephalic trunk, RSA right subclavian artery, RCCA right common carotid artery, LCCA left common carotid artery, LSA left subclavian artery.