Department of Interventional Radiology, The Frist Hospital of Lanzhou University, Lanzhou, China.
Department of Vascular and Tumour Intervention, Liangzhou Hospital, Wuwei City, Gansu Province, China.
J Cardiothorac Surg. 2023 Aug 14;18(1):244. doi: 10.1186/s13019-023-02346-7.
To evaluate the safety and effectiveness of endovascular treatment for massive haemoptysis caused by pulmonary pseudoaneurysm (PAP).
The clinical data, imaging data, and endovascular treatment protocol of 23 patients with massive haemoptysis caused by continuous PAP were retrospectively analysed. The success, complications, postoperative recurrence rate, and influence of the treatment on pulmonary artery pressure were also evaluated.
Nineteen patients with a bronchial artery-pulmonary artery (BA-PA) and/or nonbronchial systemic artery-pulmonary artery (NBSA-PA) fistula underwent bronchial artery embolization (BAE) and/or nonbronchial systemic artery embolization (NBSAE) + pulmonary artery embolization (PAE). The pulmonary artery (PA) pressures before and after embolization were 52.11 ± 2.12 (35-69 cmHO) and 33.58 ± 1.63 (22-44 cmHO), respectively (P = 0.001). Four patients did not have a BA-PA and/or NBSA-PA fistula. Embolization was performed in two patients with a distal PAP of the pulmonalis lobar arteria. Bare stent-assisted microcoils embolization was performed in the other two patients with a PAP of the main pulmonary lobar arteries. The PA pressures of the four patients before and after treatment were 24.50 ± 1.32 (22-28 cmHO) and 24.75 ± 1.70 (22-29 cmHO), respectively (P = 0.850). The technique had a 100% success rate with no serious complications and a postoperative recurrence rate of 30%.
Endovascular treatment is safe and effective for massive haemoptysis caused by PAP. BAE and/or NBSAE can effectively reduce pulmonary hypertension in patients with a BA-PA and/or NBSA-PA fistula.
评估血管内治疗肺假性动脉瘤（PAP）引起的大咯血的安全性和有效性。
回顾性分析 23 例连续 PAP 引起大咯血患者的临床资料、影像学资料和血管内治疗方案。还评估了治疗的成功率、并发症、术后复发率以及对肺动脉压力的影响。
19 例患者存在支气管动脉-肺动脉（BA-PA）和/或非支气管体循环动脉-肺动脉（NBSA-PA）瘘，行支气管动脉栓塞术（BAE）和/或非支气管体循环动脉栓塞术（NBSAE）+肺动脉栓塞术（PAE）。栓塞前后肺动脉压力分别为 52.11±2.12（35-69cmHO）和 33.58±1.63（22-44cmHO）（P=0.001）。4 例患者无 BA-PA 和/或 NBSA-PA 瘘。2 例患者肺叶动脉远端 PAP 行单纯栓塞，2 例患者主肺动脉叶动脉 PAP 行裸支架辅助微弹簧圈栓塞。4 例患者治疗前后肺动脉压力分别为 24.50±1.32（22-28cmHO）和 24.75±1.70（22-29cmHO）（P=0.850）。该技术成功率为 100%，无严重并发症，术后复发率为 30%。
血管内治疗 PAP 引起的大咯血安全有效。BAE 和/或 NBSAE 可有效降低 BA-PA 和/或 NBSA-PA 瘘患者的肺动脉高压。
