Imaging Department, Imperial College Healthcare NHS Trust, London, UK.
Department of Respiratory Medicine, Imperial College Healthcare NHS Trust, London, UK.
Eur Radiol. 2024 Dec;34(12):7786-7794. doi: 10.1007/s00330-024-10836-y. Epub 2024 Jun 11.
Bronchial artery embolization (BAE) using particles is an established treatment for hemoptysis. The use of polyvinyl alcohol (PVA) with a particle size of 300 µm or larger is thought to reduce the risk of non-target embolization but may result in more proximal vessel occlusion than is ideal, resulting in a high rate of early recurrent hemorrhage.
This study evaluates the safety and efficacy of BAE using PVA particles with a size of less than 300 µm.
All patients who underwent BAE between 2010 and 2022 at a tertiary center were included. Demographic data, etiology and volume of hemoptysis, technical and clinical success, procedure-related complications, and follow-up information were collected from patients' electronic records. 150-250 µm PVA particles were used to commence embolization in all patients with the subsequent use of larger-sized particles in some individuals. The Kaplan-Meier method was used to estimate recurrence and survival rates.
One hundred forty-four patients underwent 189 embolization procedures between 2010 and 2022 and were followed up for a median of 35 months [IQR 19-89]. 150 µm to 250 µm PVA particles were used as the sole embolic agent in 137 cases. Hemoptysis recurred within 30 days in 7%. The median time to repeat intervention was 144 days [IQR 42-441]. Seventeen out of 144 patients had a pulmonary artery branch pseudoaneurysm. The rate of major complications was 1% with no instances of stroke or spinal artery ischemia. Thirty-day mortality was 2% (4/189).
BAE using 150-250 µm PVA particles is safe and effective with few complications and low rates of early hemoptysis recurrence.
BAE using small particles is likely to improve outcomes, particularly the rate of early recurrence, in patients with hemoptysis, without an increase in procedural complications.
BAE is a safe and effective treatment for patients with hemoptysis. Using small PVA particles in BAE has few complications and low rates of early recurrence. Pulmonary artery pseudoaneurysms should be actively sought in those with hemoptysis undergoing BAE.
支气管动脉栓塞术（BAE）使用颗粒剂是治疗咯血的一种既定疗法。使用粒径为 300μm 或更大的聚乙烯醇（PVA）被认为可以降低非靶向栓塞的风险，但可能导致比理想情况下更靠近的血管闭塞，从而导致早期复发性出血的发生率较高。
本研究评估使用小于 300μm 的 PVA 颗粒进行 BAE 的安全性和有效性。
所有在 2010 年至 2022 年期间在一家三级中心接受 BAE 的患者均被纳入研究。从患者的电子病历中收集人口统计学数据、咯血的病因和出血量、技术和临床成功、与手术相关的并发症以及随访信息。所有患者均使用 150-250μm 的 PVA 颗粒开始栓塞，随后在某些患者中使用更大粒径的颗粒。使用 Kaplan-Meier 法估计复发和生存率。
2010 年至 2022 年间，144 例患者共进行了 189 次栓塞术，中位随访时间为 35 个月[IQR 19-89]。137 例患者仅使用 150μm 至 250μm 的 PVA 颗粒作为唯一栓塞剂。7%的患者在 30 天内出现咯血复发。再次介入的中位时间为 144 天[IQR 42-441]。144 例患者中有 17 例出现肺动脉分支假性动脉瘤。主要并发症发生率为 1%，无卒中或脊髓动脉缺血事件。30 天死亡率为 2%（4/189）。
使用 150-250μm 的 PVA 颗粒进行 BAE 是安全有效的，并发症少，早期咯血复发率低。
在咯血患者中，使用小颗粒进行 BAE 可能会改善结果，特别是早期复发率，而不会增加手术并发症。
BAE 是治疗咯血患者的一种安全有效的方法。在 BAE 中使用小 PVA 颗粒具有较少的并发症和较低的早期复发率。在接受 BAE 的咯血患者中应积极寻找肺动脉假性动脉瘤。
