Bronchial Artery Embolization: A Serial Clinical Study

PurposeTo evaluate the effectiveness of bronchial artery embolization for the managementof hemoptysis, and to analyze ratrospeCtively the infiuencing faCtOrs including theetiologies of hemoptysis, the embolized sites of bronchial artery and the embolicagefits used.To evaluate the tTeatinent effeCtiveness and safet of tTans-cathater bronchalederial chemo-embolization of lung cancer, and compare the clinical value of embolicagents used f particles ofgelfoam and lipiodol.To analyze the complication and its related factors haPpened in bronchial inerialembolization.MateriaIs and methodsBronchial artery embolization (BAE) was performed in 27 hemoptysis after thesite of bleeding or the abnormal arteries was identified by arteriograPhy. Particles ofgelatin sponge and polyVinyl alcohol reVA) were used seParaely as embolic agents.Stripes of gelatin sponge were used to embolize large abnormal arteries and stainlesssteels were used in arterial-venous fistula. Immediate and long-term results wereevaluated and analyzed separately by the embolized sites and the embolic agents.Chemoembolization was then performed in l35 cases of lung cancer with the use ofgelfoam particles or lipiodol separately in bronchial 8rtery or in cancer branch.In those l6l cases, the complication and its related faCtors were analyzedratrospectivelyR6sultsThe etiologies of hemoptysis were bronchiectasis, tUberculosis, lung cancer andbronchial artery malformation. Embolization performed in the main bronchial arteryin l8 patients and in its pathologic branches in 8 patiellts. Technical failure of theattempted cathaterization was observed in l patient. Pariicles of gelatin sponge wasused in l4 patients and polyVinyl alcohol reVA) in l2 patients BAE resulted in animmediate cessation of hemoptysis in 96.30% cases. One bronchial arterymalformation (3.85%) had recurrence in short4erm fOllow-uD. Mid and lonR-termrecurrent patients were 4 cases ofbronchiectasis (25%, 4/l6), all of them embolizedin the main bronchial artery and most of them embolized with particles of gelatinsponge.85 cases were embolized with gelfoam pedicles after chemotheraPeuic infusionin bronchial artery with 23 of intercoastal artery involved. 50 cases were embolizedwith a midsre of lipoidol and carboplatin after chemotheraPeuic infusion, with 4l ofthem performed in tumor artery branches, others pefformed in bronchial atery with 3of intercoastal artery involved. The clinical effectiveness (the rate of CR plus PR) ofpatients with lipoidol chemoembolization was significalltly higher than that of thoseembolized with gelfoam particles(76% vs 55.3%, p<0.05),there had no significantlydifference in the improvement rate of clinical symPtoms(44% vs 35%,P>0.05).Vessel obliteration of the tumor after embolization was obvious.Complications haPpened in 6.2% cases, consisted of spinal cord injury(l.2%),intercoastal artery ischemia (3.7%),and pulmonary arterial embolization(l .2%). Spinalcord injury and intercoastal symptoms occurred with bronchial artery embolizationother than its branches.2 cases of spinal cord injury haPpened in 355um ~ 500 umPVA group and lipiodoI group seperately, while pulmonary arterial emboIization inlipiodol group and illtercoaStal symptoms in all three groups.ConcIusionsBAE achieved satisfaCtory immediate cessation of hemoptysis and short-termolltcomes. Mid- and long-term recurrence was corresponding with the stiology ofhemoptysis, and also influenced by the embolized sites of bronchial allery and theembolic agents used. APplication of superselective BAE with microcatheters andPVA was a means of choice.Transcatheter bronchial arterial chemo-embolization of lung cancer achieved bedershort4erm effect. Chemo-embolization with gelfoam p8rticles is a relatively safeprocedure. Lipiodol chemo-embolization gained better clinical results, but should beperfbrmed more carefully and selectively with tumor branches catheterized...