Tsukahara Yoshinori, Kurozumi Masahiro, Matsuda Jun, Nonaka Tomofumi, Suzuki Takeshi, Fukamatsu Fumiaki, Suzuki Yusuke, Fujinaga Yasunari
Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan.
First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan.
Radiol Case Rep. 2024 Jul 24;19(10):4260-4265. doi: 10.1016/j.radcr.2024.06.093. eCollection 2024 Oct.
Primary racemose hemangioma of the bronchial artery (RHBA) is a rare congenital condition characterized by enlarged and convoluted bronchial arteries, often forming fistulas between the pulmonary artery or vein. Herein, we report a case of balloon-assisted embolization using N-butyl-2-cyanoacrylate (NBCA) performed for a primary RHBA in an asymptomatic 57-year-old woman. There were 2 tortuous and dilated branches of the right bronchial artery (RBA) (arising from the left subclavian artery and the descending thoracic aorta) which merged in the right pulmonary hilar region, forming multiple aneurysms that short-circuited the right pulmonary artery. Embolization was performed via the RBA arising from the subclavian artery using a triaxial system (a 5-Fr guiding catheter, a 2.7-Fr microballoon catheter, and a 1.9-Fr microcatheter). The guiding catheter was inserted into the peripheral side of the RBA using the microballoon catheter as an anchor; the balloon was slightly inflated and advanced further into the peripheral side using blood flow. The microcatheter was inserted as close to the aneurysms as possible and embolization was done using an NBCA-iodized oil mixture under blood flow control by the microballoon catheter. Bronchial artery embolization is the treatment of choice for primary RHBA because of the risk of rupture, and balloon-assisted techniques can help guide the catheter distally while also controlling blood flow.
支气管动脉原发性蔓状血管瘤（RHBA）是一种罕见的先天性疾病，其特征为支气管动脉增粗和迂曲，常形成肺动脉或肺静脉之间的瘘。在此，我们报告一例使用N-丁基-2-氰基丙烯酸酯（NBCA）进行球囊辅助栓塞治疗无症状57岁女性原发性RHBA的病例。有2支迂曲扩张的右支气管动脉分支（分别起自左锁骨下动脉和胸降主动脉），在右肺门区汇合，形成多个使右肺动脉短路的动脉瘤。通过使用三轴系统（5F引导导管、2.7F微球囊导管和1.9F微导管）经锁骨下动脉发出的右支气管动脉进行栓塞。以微球囊导管为锚定物，将引导导管插入右支气管动脉外周侧；微球囊轻微充盈，并利用血流进一步向外周侧推进。将微导管尽可能靠近动脉瘤插入，并在微球囊导管控制血流的情况下，使用NBCA-碘化油混合物进行栓塞。由于存在破裂风险，支气管动脉栓塞是原发性RHBA的首选治疗方法，球囊辅助技术有助于将导管向远端引导，同时控制血流。
