Cha Jung Guen, Hong Jihoon, Kim Gab Chul, Park Byunggeon, Park Jongmin, Park Seo Young, Shin Kyung Min, Lim Jae-Kwang, Lee So Mi
Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 680 Gukchaebosang-ro, Jung-gu, Daegu, 41944, South Korea.
Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, 807, Hogukno, Buk-gu, Daegu 41404, South Korea.
Curr Med Imaging. 2023 Nov 6. doi: 10.2174/0115734056280554231030092246.
The efficacy of bronchial artery embolization (BAE) for bronchial Dieulafoy's disease (BDD) has not been well established.
This study aimed to evaluate the safety and efficacy of BAE in patients with clinically suspected BDD presenting with major hemoptysis, and to describe angiographic findings.
17 patients (all men; mean age, 53.5 years) diagnosed with clinically suspected BDD by bronchoscopy (n = 7) or CT angiography (CTA) (n = 10) and who underwent BAE after directional and segmental localization of the target bronchus were enrolled. BAE was performed at the culprit bronchial artery traveling toward the target bronchus, regardless of the pathologic angiographic findings. Angiographic findings and clinical outcomes of BAE, including technical and clinical success, complication, recurrent hemoptysis, and follow-up imaging, were retrospectively reviewed.
Representative angiographic findings included parenchymal hypervascularity prominent in the lobe where the BDD was located (82.4%), bronchial artery hypertrophy (70.6%), and contrast extravasation into the bleeding bronchus (17.6%). BAE was technically successful in all patients. All hemoptysis ceased within 24 h. No procedure-related complications occurred. During a mean follow-up of 491.9 days, 1 (6%) patient experienced recurrent hemoptysis. Follow-up bronchoscopy or CT performed in 10 (58.8%) patients showed the disappearance of pre-existing lesions (n = 9) or glue cast within the target bronchial artery (n = 1).
Bronchial angiography showed pathologic findings in most patients with clinically suspected BDD. BAE assisted by bronchoscopy or CTA localization is a safe and effective treatment for patients with clinically suspected BDD with excellent short- to mid-term results.
支气管动脉栓塞术（BAE）治疗支气管迪厄拉富瓦病（BDD）的疗效尚未明确。
本研究旨在评估BAE治疗临床疑似BDD且伴有大量咯血患者的安全性和疗效，并描述血管造影表现。
纳入17例患者（均为男性；平均年龄53.5岁），这些患者经支气管镜检查（n = 7）或CT血管造影（CTA）（n = 10）诊断为临床疑似BDD，并在对目标支气管进行定向和节段定位后接受了BAE。无论血管造影的病理表现如何，均在向目标支气管走行的责任支气管动脉进行BAE。回顾性分析BAE的血管造影表现和临床结果，包括技术和临床成功率、并发症、咯血复发情况以及随访影像学检查结果。
典型的血管造影表现包括BDD所在肺叶实质血管增多（82.4%）、支气管动脉增粗（70.6%）以及对比剂外渗至出血支气管（17.6%）。所有患者BAE技术操作均成功。所有咯血在24小时内停止。未发生与手术相关的并发症。在平均491.9天的随访期间，1例（6%）患者出现咯血复发。10例（58.8%）患者进行的随访支气管镜检查或CT显示原有病变消失（n = 9）或目标支气管动脉内有胶铸物（n = 1）。
支气管血管造影显示大多数临床疑似BDD患者有病理表现。支气管镜或CTA定位辅助下的BAE是治疗临床疑似BDD患者的一种安全有效的方法，近期至中期效果良好。
