Department of Cardiology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India.
Department of Cardiology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India.
Indian J Tuberc. 2021 Jan;68(1):40-50. doi: 10.1016/j.ijtb.2020.09.019. Epub 2020 Sep 28.
Bronchial artery embolization (BAE) is an urgent life-saving procedure in patients with massive hemoptysis.
This was a single center observational study wherein patients presenting with hemoptysis were evaluated and underwent BAE. Initially, a descending thoracic aortogram was performed to identify culprit vessels followed by selective catheterization of the involved vessels. Abnormal bronchial artery morphology included hypertrophied and tortuous bronchial artery (BA), focal hyperemia and hypervascularity, shunting into pulmonary artery or vein, extravasation of contrast into the lung parenchyma/cavity and BA aneurysms. Selective embolization was done using either gelfoam or polyvinyl alcohol particles. Post-procedure, follow-up was done at one month and six months with outcomes defined in terms of recurrence of hemoptysis.
A total of 187 patients underwent BAE with post-tubercular sequalae being the most common diagnosis in 157 (84%) followed by idiopathic bronchiectasis in 19 (10.2%) and aspergilloma in 7 (3.7%). A total of 246 vessels were embolized with right sided BA being more commonly involved as compared to left [143 (76.5%) vs. 35 (18.7%); P < 0.0001]. Complete resolution was observed in 183 (97.8%) 24 hours post procedure. Recurrence was reported in 34 (18.2%) patients with higher frequency in diabetics, patients with active tuberculosis and presence of aspergillomas. Multi-variate logistic regression analysis showed that diabetes, presence of an aspergilloma and feeding vessels from internal mammary artery were independent predictors of recurrent hemoptysis. Most of the complications were minor except paraparesis observed in two patients.
BAE is a safe and effective procedure for the treatment of hemoptysis of different etiologies.
支气管动脉栓塞术（BAE）是大咯血患者的紧急救命程序。
这是一项单中心观察性研究，其中出现咯血的患者接受了 BAE 评估和治疗。首先进行降主动脉造影，以确定罪魁祸首血管，然后对受累血管进行选择性导管插入术。异常的支气管动脉形态包括：支气管动脉（BA）的肥大和迂曲、局灶性充血和高血管性、向肺动脉或静脉分流、对比剂向肺实质/腔外渗以及 BA 动脉瘤。使用明胶海绵或聚乙烯醇颗粒进行选择性栓塞。术后在一个月和六个月进行随访，根据咯血复发的情况定义结果。
共有 187 例患者接受了 BAE 治疗，其中最常见的诊断是肺结核后遗症（157 例，占 84%），其次是特发性支气管扩张（19 例，占 10.2%）和曲霉瘤（7 例，占 3.7%）。共栓塞了 246 支血管，右侧 BA 比左侧更常受累[143（76.5%）比 35（18.7%）；P<0.0001]。术后 24 小时内，183 例（97.8%）患者完全缓解。34 例（18.2%）患者出现复发，糖尿病、活动性肺结核和曲霉瘤存在的患者复发频率更高。多变量逻辑回归分析显示，糖尿病、曲霉瘤存在和内乳动脉供血血管是复发性咯血的独立预测因素。大多数并发症较轻，只有两名患者出现截瘫。
BAE 是治疗不同病因咯血的一种安全有效的方法。
