Habert Paul, Puech Basile, Coiffard Benjamin, Secq Véronique, Thomas Pascal, Bec Romain, Vidal Vincent, Mancini Julien, Bermudez Julien, Reynaud-Gaubert Martine, Gaubert Jean-Yves
Imaging Department, Hopital Nord, APHM, Aix Marseille University; Aix Marseille Univ, LIIE, Marseille, France; Aix Marseille Univ, CERIMED, Marseille, France.
Imaging Department, Hopital Nord, APHM, Aix Marseille University.
J Cyst Fibros. 2022 Nov;21(6):1042-1047. doi: 10.1016/j.jcf.2022.04.015. Epub 2022 May 1.
Haemoptysis is a life-threatening complication of cystic fibrosis (CF). One treatment is bronchial artery embolisation (BAE) using embolic-microspheres (EMs). During BAE, pulmonary arteries can be seen on digital subtracted angiography while iodine containing contrast material injection is performed in the bronchial artery. This suggests that EMs could go from bronchial to nontarget pulmonary arteries. The aim was to evaluate if EMs could be found inside pulmonary arteries on lung explants after BAE in transplanted CF patients.
Retrospective observational study including patients with CF who underwent lung transplantation and had previously needed BAE. Clinical, chest CT angiography, and angiographic data were reviewed from medical records. Pathology examination of lung explants was performed to analyze the EMs anatomical localisation.
Eight patients were included between 2013 and 2015, four males with a mean age of 29 (19-45) years. All patients had bronchial artery hypertrophy on CT and bronchial-to-pulmonary artery shunting during BAE. On pathology examination, EM ≤800 µm were found in the pulmonary arteries in all patients and were responsible for distal branch occlusions. Two pulmonary infarcts were observed on CT angiography after BAE and confirmed histopathologically.
EM migration from the bronchial to pulmonary arteries is a common occurrence after BAE in patients with advanced stage CF. Although BAE is a highly effective means of controlling haemoptysis in CF, studies on the optimal particle size are needed to preserve pulmonary artery circulation, because these results suggest that low size EMs could lead to nontarget embolisation.
咯血是囊性纤维化（CF）的一种危及生命的并发症。一种治疗方法是使用栓塞微球（EMs）进行支气管动脉栓塞（BAE）。在BAE过程中，在支气管动脉注射含碘造影剂时，数字减影血管造影可显示肺动脉。这表明EMs可能从支气管动脉进入非靶肺动脉。目的是评估在移植的CF患者接受BAE后，肺外植体的肺动脉内是否能发现EMs。
回顾性观察研究，纳入接受肺移植且先前需要BAE的CF患者。从病历中查阅临床、胸部CT血管造影和血管造影数据。对肺外植体进行病理检查以分析EMs的解剖定位。
2013年至2015年纳入8例患者，4例男性，平均年龄29（19 - 45）岁。所有患者CT显示支气管动脉增粗，BAE过程中存在支气管-肺动脉分流。病理检查发现，所有患者肺动脉内均有直径≤800 µm的EMs，导致远端分支闭塞。BAE后CT血管造影观察到2例肺梗死，并经组织病理学证实。
晚期CF患者BAE后，EMs从支气管动脉迁移至肺动脉是常见现象。虽然BAE是控制CF咯血的一种高效方法，但由于这些结果表明小尺寸EMs可能导致非靶栓塞，因此需要开展关于最佳粒径的研究以保护肺动脉循环。
