Abstract:

Objective To evaluate the value of superselective transcatheter arterial embolization (interventional embolization) guided by digital subtraction angiography (DSA) before pulmonary lobectomy in patients with refractory hemoptysis. Methods We analyzed retrospectively the clinical data of 45 consecutive patients admitted in Shandong Provincial Chest Hospital due to refractory hemoptysis requiring lobectomy. Twenty patients underwent interventional embolization before lobectomy as research group, and 25 patients without interventional embolization before lobectomy as control group. The distribution of blood vessels responsible for hemoptysis, the relationship between primary disease and the effect of interventional embolization were observed. The differences in operative time, bleeding volume and incidence of complications between the two groups were compared. T test was used to compare the measurement data between groups, and χ² test was used to compare the enumeration data between groups, with P<0.05 as the statistical significance. Results DSA revealed that there were 57 vessels responsible for bleeding in 20 patients in the research group, including 12 bronchial arteries (BA), 42 collateral arteries of non-bronchial body arteries (NBSA), and 3 pulmonary arteries (PA). Of 42 NBSA branches,29 branches were from intercostal artery, subclavian artery and axillary artery,in 11 cases with tuberculous destroyed lung and cavity complicated with aspergillus ball, and 13 branches were from esophageal proper artery and inferior phrenic artery in 9 cases with bronchiectasis. There were 13 (65.0%) cases of hemostasis immediately stop after interventional embolization, and 7 (35.0%) cases hemoptysis alleviating. The average intraoperative bleeding volume was (600±155)ml in the research group and that was (850±210)ml in the control group. There was significant difference between the two groups (t=23.73,P=0.000). The operative time was (150±35)min in the research group, and that was (180±40)min in the control group. The difference between the two groups was statistically significant (t=12.40,P=0.000).Conclusion NBSA is the main blood vessel responsible for refractory hemoptysis, and its distribution is related to the primary disease. Preoperative interventional embolization is helpful to control hemoptysis, and can effectively alleviate intraoperative bleeding, shorten the operation time, thereby reducing the risk of operation.

Key words: Hemoptysis, Radiology, interventional, Embolization, therapeutic, Pneumonectomy, Evaluation studies