Three‐dimensional imaging anatomical research and clinical implications of V¹ ⁺²d in the left upper lung

Background To investigate the distribution pattern of V 1+2 d in the left superior pulmonary vein and its clinical significance. Methods A retrospective analysis was conducted using three‐dimensional computed tomographic bronchography and angiography (3D‐CTBA) data from 500 lung cancer patients. Statistical analyses were performed to evaluate the incidence and drainage patterns of the three sub‐branches of V 1+2 d, namely V 1+2 d1, V 1+2 d2 and V 1+2 d3. Furthermore, clinical data from 10 patients' lesions involving V 1+2 d were reviewed to illustrate the impact of adjacency to V 1+2 d on the surgical approach. Results The incidences of V 1+2 d1, V 1+2 d2 and V 1+2 d3 were 100%, 76.4% and 100% respectively. The relative interlobar distribution sizes of B 3 a and B 1+2 c and the left upper division (LUD) vein type influenced the incidence of V 1+2 d2 ( p < 0.05; p < 0.001). V 1+2 d2 predominantly occurred in B 3 a = B 1+2 c and B 1+2 c > B 3 a patterns. V 1+2 d2 was entirely absent in the B 3 a > B 1+2 c pattern. V 1+2 d2 exhibited a higher incidence in both the central vein (CV) type and the noncentral vein (NCV) type when compared to the semi‐central vein (SCV) type (100% vs. 100% vs. 64.8%). The most prevalent venous drainage pattern was the three sub‐branches of V 1+2 d constituting a major trunk to drain (41.2%). All 10 cases with lesions involving V 1+2 d successfully underwent sublobar resection with no complications, and the surgical margin was ≥2 cm. Conclusions The three sub‐branches of V 1+2 d exhibit a high incidence with diverse distribution patterns, yet a discernible pattern exists. For inter‐ or multi‐intersegmental nodules involving V 1+2 d, combined segmentectomy and subsegmentectomy or combined subsegmentectomy can ensure the safe margin.