食管固有动脉作为非支气管性体动脉参与咯血的介入诊断与治疗

Proper esophageal artery as a non-bronchial systemic feeding artery in hemoptysis:its angiography and embolization

目的探讨食管固有动脉(PEA)参与咯血供血的DSA表现及聚乙烯醇(PVA)栓塞治疗的安全性。方法回顾分析196例咯血保守治疗无效行介入治疗患者的资料,共有32例为异常PEA患者,其中支气管扩张27例,肺部慢性炎症3例,结核性支气管扩张2例,病变均累及肺下叶。分析患者病变PEA的数目、DSA表现、与肺部病变部位、性质的关系,以及PVA栓塞相关并发症。结果 32例患者的DSA表现为血管增粗、迂曲,分支增多、紊乱并进入相邻肺组织。30例(93.75%)PEA与肺动脉交通;PEA供血的肺部病变93.9%位于肺下叶后基底段。未发现与PVA栓塞相关的并发症。结论 PEA可参与咯血供血,当肺内病变累及下叶时,需探查PEA,应用PVA颗粒栓塞异常PEA安全。

Objective To investigate the angiographic manifestations of the proper esophageal artery （PEA） that acts as a non-bronchial systemic feeding artery in hemoptysis, and to discuss the safety of embolization therapy with polyvinyl alcohol （PVA） particles. Methods A total of 196 cases with massive hemoptysis, who had to receive interventional embolization therapy as the conservative treatment exerted no effect, were enrolled in this study. The clinical data were retrospectively analyzed. Of the 196 patients, the pulmonary lesion that received additional blood supply from PEA was found in 32. The pulmonary lesions included bronchiectasis （n = 27）, chronic pulmonary inflammation （n = 3） and tuberculous bronchieetasis （n = 2）. All the pulmonary lesions involved lower lobes. The number of PEAs and the DSA findings were determined, and their relationship to the lesion＇s site and nature, as well as the embolizatiou- related complications were analyzed. Results In 32 patients having additional blood supply from PEA, tortuous, dilated, disordered and hyper-branched vessels that penetrated into the adjacent lung were seen on DSA. PEA participated in lesion＇s blood supply in 30 cases （93.75%）, and 93.9% of PEA-feeding pulmonary lesions were located at the posterior basal segment of the lower lobe. No PVA embolization- related complications occurred. Conclusion Proper esophageal artery, which acts as a non- bronchial systemic feeding artery, can supply blood to the lung lesions in hemotypsis. When the pulmonary lesion involves the lower lobes, signs of blood supply from PEA should be carefully searched for on DSA. Additional embolization of PEA using PVA particles is quite safe in the management of hemoptysis. （J Intervent Radiol, 2013, 22： 734-737）