The utility of three-dimensional computed tomography bronchography and angiography technology in pulmonary sequestration surgery.

BACKGROUND: Accurately delineating the intricate vascular and bronchial anatomy of sequestered lung tissue poses significant challenges in pulmonary sequestration (PS) resection. Although conventional two-dimensional (2D) imaging remains indispensable, its limitations in spatial resolution are frequently associated with intraoperative uncertainties. This study investigates the clinical applicability of three-dimensional computed tomography bronchography and angiography (3D-CTBA) for preoperative planning and intraoperative guidance in PS surgery.

METHODS: In this retrospective cohort study conducted at a single tertiary center, we enrolled 22 consecutive intralobar PS patients scheduled for surgical resection between January 2021 and October 2024. All study participants underwent preoperative 3D-CTBA reconstruction to formulate individualized surgical strategies. Anatomical accuracy of the three-dimensional (3D) models was rigorously validated against intraoperative observations, while procedural safety was assessed by recording intraoperative complications, including iatrogenic injury to aberrant artery and adjacent tissue.

RESULTS: The surgical team conducted preoperative planning for all patients using 3D reconstruction models. Ultimately, five patients (22.7%) underwent sublobar resection, while the remaining 17 patients (77.3%) underwent lobectomy. Two cases involving arteries originating from uncommon sites were undetected in computed tomography (CT) imaging, and one patient with three thoracic aortic arteries was misclassified as having only a single aberrant artery. However, the 3D-CTBA models demonstrated complete consistency with intraoperative findings. The surgical team confirmed complete concordance (100%) between the 3D reconstructions and intraoperative anatomical findings, with all procedures resulting in no iatrogenic injuries to aberrant arteries or adjacent tissues.

CONCLUSIONS: Our findings preliminarily establish 3D-CTBA as a reliable strategy for PS surgery, effectively addressing the dual challenges of aberrant vessel identification and parenchymal preservation, particularly in complex cases (e.g., patients with arteries originating from rare systemic arterial circulation or having multiple aberrant arteries). We believe that 3D-CTBA technology holds significant promise for the surgery of PS, and we anticipate its widespread use in patients with complex pulmonary malformations in the future. Further large-scale, multicenter, prospective studies are required to further confirm our findings.