Zhao Tian, Wang Sini, Zheng Lili, Jia Zhongzhi, Yang Yunjun, Wang Weiping, Sun Houzhang
Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Department of Interventional Radiology, No. 2 People's Hospital of Changzhou, Nanjing Medical University, Changzhou, China.
J Vasc Interv Radiol. 2017 Apr;28(4):533-541.e1. doi: 10.1016/j.jvir.2017.01.006. Epub 2017 Mar 2.
To retrospectively assess the value of computed tomographic (CT) bronchial arteriography (BA) with 320-row multidetector CT in the management of patients with recurrent hemoptysis immediately after bronchial artery embolization (BAE).
Among 135 consecutive patients treated with BAE between April 2014 and March 2016, recurrent hemoptysis developed in 15, and 10 subsequently underwent multidetector CT. Vascular abnormalities and associated anatomy were evaluated to determine the potential cause of BAE failure, and the clinical impacts of CT BA were analyzed.
CT BA revealed an additional 22 abnormal vessels in the qualified 10 patients, and 8 patients were treated again within 24 hours after the first BAE based on multidetector CT findings. Of the 22 abnormal vessels, 16 were embolized, including 4 orthotopic arteries, 8 ectopic arteries, and 4 nonbronchial systemic arteries (NBSAs); the remaining 6 abnormal arteries were not embolized because of normal BA (n = 1), anatomic inaccessibility (n = 2), or cessation of hemoptysis with conservative therapy (n = 3). There were no further cases of recurrent hemoptysis after the second intervention, with a mean follow-up of 7.7 months ± 6.7. Overall, initial conventional BA missed 65% of potential bleeding arteries (22 of 34). After CT BA, 73% of the newly identified vessels (16 of 22) were embolized.
Multiple unrecognized abnormal ectopic bronchial arteries and NBSAs are the major causes of failure of initial BAE. Multidetector CT BA can precisely identify a large number of feeding vessels that are missed on conventional BA, allowing for repeat embolization with a high success rate.
回顾性评估320排多层螺旋CT支气管动脉造影（CT BA）在支气管动脉栓塞术（BAE）后即刻复发性咯血患者治疗中的价值。
2014年4月至2016年3月期间连续接受BAE治疗的135例患者中，15例出现复发性咯血，其中10例随后接受了多层螺旋CT检查。评估血管异常及相关解剖结构以确定BAE失败的潜在原因，并分析CT BA的临床影响。
CT BA在合格的10例患者中发现另外22条异常血管，8例患者根据多层螺旋CT检查结果在首次BAE后24小时内再次接受治疗。在这22条异常血管中，16条进行了栓塞，包括4条原位动脉、8条异位动脉和4条非支气管体动脉（NBSAs）；其余6条异常动脉因BA正常（n = 1）、解剖位置难以到达（n = 2）或保守治疗后咯血停止（n = 3）而未栓塞。第二次干预后无进一步复发性咯血病例，平均随访7.7个月±6.7个月。总体而言，最初的传统BA遗漏了65%的潜在出血动脉（34条中的22条）。CT BA后，新发现血管的73%（22条中的16条）进行了栓塞。
多条未被识别的异常异位支气管动脉和NBSAs是初始BAE失败的主要原因。多层螺旋CT BA能够精确识别传统BA遗漏的大量供血血管，从而使重复栓塞术成功率较高。
