Bronchial artery embolization using small particles is safe and effective: a single center 12-year experience.

Autor: Sheehan F; Imaging Department, Imperial College Healthcare NHS Trust, London, UK., Graham A; Imaging Department, Imperial College Healthcare NHS Trust, London, UK., Tait NP; Imaging Department, Imperial College Healthcare NHS Trust, London, UK., Ind P; Department of Respiratory Medicine, Imperial College Healthcare NHS Trust, London, UK., Alsafi A; Imaging Department, Imperial College Healthcare NHS Trust, London, UK. a.alsafi@imperial.ac.uk.; Department of Surgery and Cancer, Imperial College London, London, UK. a.alsafi@imperial.ac.uk., Jackson JE; Imaging Department, Imperial College Healthcare NHS Trust, London, UK.
Jazyk: angličtina
Zdroj: European radiology [Eur Radiol] 2024 Dec; Vol. 34 (12), pp. 7786-7794. Date of Electronic Publication: 2024 Jun 11.
DOI: 10.1007/s00330-024-10836-y
Abstrakt: Background: 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.
Objective: This study evaluates the safety and efficacy of BAE using PVA particles with a size of less than 300 µm.
Methods: 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.
Results: 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).
Conclusion: BAE using 150-250 µm PVA particles is safe and effective with few complications and low rates of early hemoptysis recurrence.
Clinical Relevance Statement: 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.
Key Points: 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.
Competing Interests: Compliance with ethical standards Guarantor The scientific guarantor of this publication is Ali Alsafi. Conflict of interest The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. Statistics and biometry No complex statistical methods were necessary for this paper. Informed consent Written informed consent was obtained from all subjects (patients) in this study. Ethical approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This retrospective review of the institution’s practice was approved by the local audit committee under the Health and Social Care Research Framework. Study subjects or cohorts overlap None of the study subjects or cohorts have been included in previous reports. Methodology RetrospectiveObservationalPerformed at one institution
(© 2024. The Author(s).)
Databáze: MEDLINE
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