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Safety and efficacy of transcatheter embolization in patients with massive hemoptysis due to intercostal pulmonary venous shunts

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Abstract

Purpose

Bronchial hemoptysis induced by intercostal pulmonary venous shunt (IPVS) is clinically rare. Pulmonary lesions on pleural surface may facilitate opening of vascular network. This retrospective study investigated safety and efficacy of embolization agents with small-particle embolization treating patients with massive hemoptysis due to IPVS.

Methods

Patients with massive hemoptysis (n = 207) underwent computed tomography angiography of bronchial artery. Depending on results, selective or superselective digital subtraction angiography and embolization were performed. Polyvinyl alcohol (300–500 μm), or microcoils combined with polyvinyl alcohol, was utilized according to IPVS volume. Vital signs of each patient were closely monitored.

Results

Of 207 patients with massive hemoptysis, 24 (11.6%) had IPVS syndrome. Patients with IPVS had concomitant bronchiectasis (54.2%), followed by tuberculosis (25.0%). Embolizations were performed in 39 culprit intercostal arteries; 37 (94.9%) of these were successfully embolized. Of the latter, 30 and 7 arteries were embolized, respectively, by polyvinyl alcohol alone or polyvinyl alcohol particles combined with microcoils. Embolization failed in one case because the agents could not enter the intercostal artery. If artery dissection occurred during procedure, microcoils were utilized to embolize the main artery. No skin necrosis, spinal artery embolization, or death occurred. Immediate clinical success was achieved in 22 patients (91.7%) after embolization. Two patients (8.3%) experienced recurrence of hemoptysis. Only four patients experienced mild hemoptysis during the 24-month follow-up with the efficiency of 75.0%.

Conclusions

Intercostal artery embolization with 300–500 μm alone or combined with microcoils is a safe and effective procedure in patients with IPVS-induced bronchial hemoptysis.

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Authors and Affiliations

  1. First College of Clinical Medical Science, China Three Gorges University, Yichang, 443003, China

    Zhigang Fu, Yonghui Liang & Xiaolin Zhang

  2. Department of Radiology, Yichang Central People’s Hospital, 183 Yiling Road, Yichang, 443003, China

    Zhigang Fu, Yonghui Liang, Wengjiang Zhao, Jie Tian, Fei Cai & Xiaolin Zhang

Authors
  1. Zhigang Fu
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  2. Yonghui Liang
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  3. Wengjiang Zhao
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  4. Jie Tian
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  5. Fei Cai
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  6. Xiaolin Zhang
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Corresponding author

Correspondence to Xiaolin Zhang.

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Conflict of interest

Yonghui LIANG declares that he has no conflict of interest. Yonghui LIANG declares that he has no conflict of interest. Wengjiang ZHAO declares that he has no conflict of interest. Jie TIAN declares that he has no conflict of interest. Fei CAI declares that he has no conflict of interest. Xiaolin ZHANG declares that he has no conflict of interest.

Ethical approval

This study was approved by the Medical Ethics Committee at the first Affiliated Hospital with China Three Gorges University and Ethics Committee/IRB (ethics no. 2017-001-04). Written informed consent was obtained from each included patient.

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Informed consent was obtained from all individual participants included in the study.

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Fu, Z., Liang, Y., Zhao, W. et al. Safety and efficacy of transcatheter embolization in patients with massive hemoptysis due to intercostal pulmonary venous shunts. Radiol med 124, 588–594 (2019). https://doi.org/10.1007/s11547-019-01020-0

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  • DOI: https://doi.org/10.1007/s11547-019-01020-0

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