支气管动脉栓塞术

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C hapter Summary

B ackground

• C F most common cause of hemoptysis (see Table 6.5)

• M edical therapy often successful:

–S top chest physiotherapy and penicillin

–V itamin K, tranexamic acid

–V asopressin, octreotide

–A ntibiotics

• E ndoscopic and surgical treatment possible • E mbolization—fi rst-line treatment

• S ystemic supply usually:

–B ronchial—variable anatomy

–C ollaterals:

∘Subclavian branches

∘Intercostal

∘Phrenic

∘Left gastric

∘Esophageal

• S hunts possible:

–S pinal cord, carotid/vertebral circulation

–U p to 325 μm in size

I ndications

• M edical management failed

• M assive/moderate hemoptysis

• C onsider in chronic/recurrent when:

–P revious massive hemoptysis

–R ecurrent hemoptysis <2 weeks post-treatment

–N ot responding to treatment

–B ridge to transplantation

P reprocedure Evaluation

• H ematology and coagulation profi le

• A ttempt to identify site:

–C linical history

–I maging—CXR, CT

–B ronchoscopy

E quipment

• C atheters, 4–5 Fr:

–R everse curve (Sos, Simmons, etc.)

–A ngled (vertebral)

–M icrocatheters

–P igtail • E mbolic agent:

–P V A, gelatin sponge, spherical, glue

–C oils not recommended unless very distal • 4–5 Fr vascular sheath

T echnique

• U sually GA (especially younger patients) • F emoral access

• A uthor’s suggested order of investigation:–B ilateral subclavian arteries and branches (if indicated)

–R ight intercostal bronchial trunk (switch to reverse curve catheter if necessary) –O ther bronchial arteries

–A ortogram

• P V A common embolic material:

–300–500 μm size

–U p to 1,000 μm used when large shunts seen • M onitor for collaterals to spine and cerebral circulation (consider higher fl uoroscopy rate during embolization)

P ostprocedure Care

• S upportive care

• P ost-embolization syndrome can occur

• D/C home average 2 days post

O utcomes/Complications

• >90 % successful

• R ecurrent hemoptysis common

• D eath—10–40 %

–O ften complication of anesthesia:

∘Consider potential for extracorporeal membrane oxygenation if high risk

• N ontarget embolization:

–S pinal ischemia:

∘Can be self-limited

∘Avoid small particles!

–M yocardial infarction

–S troke, cortical blindness

–P hrenic nerve palsy

–I schemic colitis

–P eripheral ischemia

• P ain

• D ysphagia

• E sophageal fi stula

• P ulmonary/bronchial infarction

• A rterial dissection

6 Bronchial Artery Interventions in Children