Keshmiri Mohammad Sadegh, Shafaghi Shadi, Sharif-Kashani Babak, Sadoughi Ali, Ghorbani Fariba, Naghashzadeh Farah, Abedini Atefeh
Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Multidiscip Respir Med. 2020 Dec 30;15(1):723. doi: 10.4081/mrm.2020.723. eCollection 2020 Jan 28.
Massive hemoptysis which is presented in advanced lung diseases is a life-threatening condition. Bronchial artery embolization as a minimally invasive procedure is the treatment of choice either in first or recurrent hemoptysis. This study aimed to assess the early and late efficacy of bronchial angioembolization (BAE) without microcatheter.
In this prospective cohort study, all patients with hemoptysis who had undergone BAE from August 2018 to March 2019 were included. Angiographic patterns including bleeding sources, number of involved vessels, the underlying etiology, and recurrence rate were evaluated in a one-year follow up.
153 patients were included with mean age of 55 ±16 years. 68% of them were male and 58% had life-threatening massive hemoptysis. Three distinct angiographic patterns were recognized. The culprit bleeding vessel was bronchial in 126 (92%), intercostal in 4 (3%), and both vessels in 7 (5%) of cases (p<0.05). One vessel involvement was seen in 56 patients; however it was observed in 69% of non-cystic fibrosis lobar bronchiectasis patients. In 1, 3 and 12 months follow up, recurrent hemoptysis was reported in 15 (11%), 4 (2.5%), and 24 (15.5%), respectively. In 52% of cases, no abnormal vessels were observed during aorta injection, but culprit bronchial or intercostal arteries were found in selective investigational angiography.
BAE was successful in the control of hemoptysis and resulted in a low rate of recurrence in different types of lung diseases. This could be due to the embolization of all pathological arteries found during angiography which might have prevented recurrent bleeding.
晚期肺部疾病出现的大量咯血是一种危及生命的状况。支气管动脉栓塞作为一种微创手术，是初次或复发性咯血的首选治疗方法。本研究旨在评估无微导管支气管血管栓塞术（BAE）的早期和晚期疗效。
在这项前瞻性队列研究中，纳入了2018年8月至2019年3月期间接受BAE治疗的所有咯血患者。在一年的随访中评估血管造影模式，包括出血来源、受累血管数量、潜在病因和复发率。
纳入153例患者，平均年龄55±16岁。其中68%为男性，58%有危及生命的大量咯血。识别出三种不同的血管造影模式。咯血的责任血管为支气管动脉的有126例（92%），肋间动脉的有4例（3%），两者均有的有7例（5%）（p<0.05）。56例患者可见单支血管受累；然而，在非囊性纤维化肺叶支气管扩张患者中，这一情况见于69%的患者。在1个月、3个月和12个月的随访中，分别有15例（11%）、4例（2.5%）和24例（15.5%）报告有复发性咯血。52%的病例在主动脉注射期间未观察到异常血管，但在选择性研究血管造影中发现了责任支气管或肋间动脉。
BAE成功控制了咯血，且在不同类型的肺部疾病中复发率较低。这可能是由于对血管造影中发现的所有病理性动脉进行了栓塞，从而可能预防了再次出血。
