Die Bronchialarterien – ein kleiner, aber lebenswichtiger Beitrag zur Lungenperfusion nach Lungentransplantation

Zusammenfassung

Die Blutversorgung der Lunge besteht aus dem pulmonal- und dem bronchial-arteriellen System. Die bronchial-arteriellen Gefäße sind an der nutritiven Versorgung der kleinen Atemwege bis hin zu den terminalen Bronchiolen beteiligt. Zudem sind sie bedeutsam für die Regulation der Atemwegstemperatur, der -feuchtigkeit sowie der mukoziliären Clearance. Eine chronische Ischämie der kleinen Atemwege durch Verlust oder Verletzung der bronchial-arteriellen Versorgung erhöht das Risiko für eine Fibrosierung der kleinen Atemwege (obliterative Bronchiolitis), im Speziellen bei einer Lungentransplantation (LTx). Wenngleich sich die Überlebensrate nach LTx im Verlauf verbessert hat, ist sie noch immer deutlich schlechter als bei anderen Organtransplantationen mit einer 5-Jahres-Überlebensrate von 50 bis 60%. Es ist zu vermuten, dass eine bronchial-arterielle Revaskularisierung zum Zeitpunkt der LTx eine wichtige transplantaterhaltende Funktion hat.

Abstract

Blood supply to the lungs is carried out by the pulmonary and bronchial-arterial system. The bronchial-arterial vessels are involved in supplying the small airways all the way up to the terminal bronchioles. The bronchial-arterial system is also necessary for the regulation of airway temperature, humidity and mucociliary clearance. Chronic ischaemia of the small airways due to damage or injury to bronchial arterial supply increases the risk of fibrosis of the small airways (bronchiolitis obliteration), especially in lung transplantation (LTx). Although survival after LTx has improved over time, it is, with a 5-year survival rate of only 50 to 60%, still significantly worse than that of other organ transplants. It is likely that bronchial arterial revascularisation at the time of LTx plays an important transplant-preserving function.

Schlüsselwörter

Bronchialarterie - Ischämie - Lungentransplantation - Revaskularisierung - Bronchiolitis obliterans

Keywords

bronchial artery - ischaemia - lung transplantation - revascularisation - bronchiolitis obliterans

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