First College of Clinical Medical Science, China Three Gorges University, Yichang, 443003, China.
Department of Radiology, Yichang Central People's Hospital, 183 Yiling Road, Yichang, 443003, China.
Radiol Med. 2019 Jul;124(7):588-594. doi: 10.1007/s11547-019-01020-0. Epub 2019 Mar 9.
Bronchial hemoptysis induced by intercostal pulmonary venous shunt (IPVS) is clinically rare. Pulmonary lesions on pleural surface may facilitate opening of vascular network. This retrospective study investigated safety and efficacy of embolization agents with small-particle embolization treating patients with massive hemoptysis due to IPVS.
Patients with massive hemoptysis (n = 207) underwent computed tomography angiography of bronchial artery. Depending on results, selective or superselective digital subtraction angiography and embolization were performed. Polyvinyl alcohol (300-500 μm), or microcoils combined with polyvinyl alcohol, was utilized according to IPVS volume. Vital signs of each patient were closely monitored.
Of 207 patients with massive hemoptysis, 24 (11.6%) had IPVS syndrome. Patients with IPVS had concomitant bronchiectasis (54.2%), followed by tuberculosis (25.0%). Embolizations were performed in 39 culprit intercostal arteries; 37 (94.9%) of these were successfully embolized. Of the latter, 30 and 7 arteries were embolized, respectively, by polyvinyl alcohol alone or polyvinyl alcohol particles combined with microcoils. Embolization failed in one case because the agents could not enter the intercostal artery. If artery dissection occurred during procedure, microcoils were utilized to embolize the main artery. No skin necrosis, spinal artery embolization, or death occurred. Immediate clinical success was achieved in 22 patients (91.7%) after embolization. Two patients (8.3%) experienced recurrence of hemoptysis. Only four patients experienced mild hemoptysis during the 24-month follow-up with the efficiency of 75.0%.
Intercostal artery embolization with 300-500 μm alone or combined with microcoils is a safe and effective procedure in patients with IPVS-induced bronchial hemoptysis.
肋间肺静脉分流（IPVS）引起的支气管咯血在临床上较为少见。胸膜表面的肺部病变可能会使血管网络更容易开放。本回顾性研究旨在探讨采用小颗粒栓塞剂对因 IPVS 导致的大咯血患者进行栓塞治疗的安全性和有效性。
207 例大咯血患者行支气管动脉计算机断层血管造影术。根据结果，选择性或超选择性数字减影血管造影和栓塞术。根据 IPVS 容积，采用聚乙烯醇（300-500μm）或微弹簧圈联合聚乙烯醇。密切监测每位患者的生命体征。
207 例大咯血患者中，24 例（11.6%）存在 IPVS 综合征。合并支气管扩张症（54.2%）的患者最多，其次为肺结核（25.0%）。39 条致病肋间动脉行栓塞术，其中 37 条（94.9%）成功栓塞。后者分别单独使用聚乙烯醇或聚乙烯醇颗粒联合微弹簧圈栓塞 30 条和 7 条动脉。1 例栓塞失败，原因是栓塞剂无法进入肋间动脉。如果在手术过程中发生动脉夹层，则使用微弹簧圈栓塞主动脉。未发生皮肤坏死、脊髓动脉栓塞或死亡。栓塞后 22 例（91.7%）患者即刻临床成功。2 例（8.3%）患者咯血复发。在 24 个月的随访中，仅有 4 例患者出现轻度咯血，有效率为 75.0%。
对于因 IPVS 导致的支气管咯血患者，采用 300-500μm 聚乙烯醇单独或联合微弹簧圈栓塞肋间动脉是一种安全有效的方法。
