Three-dimensional Imaging of Multi-slice Spiral CT in Bronchial Artery Correlative Study on Blood Supply of Central Lung Cancer and Its Clinical Significance

Objective: To evaluate three-dimensional bronchial artery imaging charactersin central lung cancer and applied values with multi-slice spiral CT (MSCT) to provide theoreticalevidence on blood supply and intervention therapy. Methods: Eighteen patients with central lungcancer underwent MSCT with real time helical thin-slice CT scanning. Three-dimensional bronchialartery reconstruction was done at the console work-station. The space anatomical characters ofbronchial artery were observed through different rotations. Results: For 6 cases, thethree-dimensional images of bronchial artery (33.33%) could exactly show the origins, the routes(lung inner segment and mediatism segment) and the diameters of bronchial arteries. Vision rate ofbronchial arteries was the highest in pulmonary artery stricture and truncation groups, and thevessels' diameter became larger apparently. These characters demonstrated blood supply of this kindof central lung cancer come from bronchial artery. Volume rendering images were the best ones amongthree-dimensional images. Conclusion: Three-dimensional imaging with MSCT in bronchial artery canreveal the anatomical characters of bronchial artery and provide theoretical evidence on bloodsupply and intervention therapy of central lung cancer.

Acute upper gastrointestinal bleeding caused by esophageal right bronchial artery fistula:A case report

BACKGROUND Fistula between the esophagus and bronchial artery is an extremely rare and potentially life-threatening cause of acute upper gastrointestinal bleeding.Here,we report a case of fistula formation between the esophagus and a nonaneurysmal right bronchial artery(RBA).CASE SUMMARY An 80-year-old woman with previous left pneumonectomy and recent placement of an uncovered self-expandable metallic stent for esophageal adenocarcinoma was admitted due to hematemesis.Emergent computed tomography showed indirect signs of fistulization between the esophagus and a nonaneurysmal RBA,in the absence of active bleeding.Endoscopy revealed the esophageal stent correctly placed and a moderate amount of red blood within the stomach,in the absence of active bleeding or tumor ingrowth/overgrowth.After prompt multidisciplinary evaluation,a step-up approach was planned.The bleeding was successfully controlled by esophageal restenting followed by RBA embolization.No signs of rebleeding were observed and the patient was discharged home with stable hemoglobin level on postoperative day 7.CONCLUSION This was a previously unreported case of an esophageal RBA fistula successfully managed by esophageal restenting followed by RBA embolization.

BRONCHIAL ARTERY CHEMOTHERAPY FOR INOPERABLE NON-SMALL-CELL LUNG CANCER

We applied low-dose cisplatin regimen delivered by an interventional method to twenty-one consecutively treated patients with inoperable NSCLC.The regimen consisted of cisplatin 50 mg/m2, mitomycin C 10 mg/m2,and 5-Fu 500 mg/m2.All patients had positive response to the treatment.The overall response rate was 76.2%(CR:23.8%,PR:52.4%).The median survival was 25.5±3.2 weeks,which was similar to those obtained by other combination chemotherapies,but the toxicity was significantly reduced. The results suggested that bronchial artery chemotherapy would give the patients with advanced NSCLC a satisfactory early results and a higher quality of life.It is advisable to select bronchial artery chemotherapy as a preoperative treatment for advanced NSCLC.

Clinical study of interventional preoperative bronchial artery infusion chemotherapy combined with surgical resection for advanced non-small cell lung cancer

Objective： How to improve the postoperative 5-year survival rate for lung cancer and to give more patients a chance of surgery have become research hotspots. The aim of this research is to evaluate the clinical and pathohistological responses and effects of preoperative bronchial artery infusion （BAI） chemotherapy in patients with locally advanced （stage Ⅲ） non-small cell lung cancer （NSCLC）. Methods： A total of 92 patients with locally advanced NSCLC were randomly divided into two groups. BAI group received BAI chemotherapy for 2 cycles before surgical resection. Surgery group received operation only. The complete resection rate and clinical response were compared between the two groups. Results： In the BAI group, the clinical response rate and the pathohistological response rate were 68.3% and 51.3%, respectively. The complete resection rate in the BAI group was 89.7%, which was significantly higher than that in the surgery group （72.5%） （P 〈 0.05）. The 1- and 2-year survival rate was 100.0% and 80.6% in the BAI group, and 94.1% and 60.0% in the surgery group. Conclusion： BAI neoadjuvant chemotherapy is safe and effective, which has a good clinical and pathohistological response. It might increase the complete resection rate of the tumor and improve the long term survival rate of stage Ⅲ NSCLC patients.

The effects on surgery and preoperative patients with non-small cell lung cancer by preoperative bronchial artery infusion chemotherapy

Objective： To study the efficiency, safety and feasibility of preoperative bronchial artery infusion （BAI） chemotherapy on operation in patients with locally advanced （stage Ⅲ） non-small cell lung cancer （NSCLC）. Methods： 92 cases with locally advanced NSCLC patients were randomly divided into two groups： （1） BAI chemotherapy group： 39 cases were received BAI chemotherapy for 2 courses and followed surgery; （2） surgery alone group： 51 cases were treated by operation alone. The complete resection rate and preoperative complications were compared between these two groups. Results： In BAI chemotherapy group, the rate of clinical efficiency was 68.3% with slight toxicity. In BAI chemotherapy group the surgery complete resection rate was 89.7%, which was significantly higher than that in surgery alone group （72.5%, P 〈 0.05）. No significant differences of blood loss, operative complications and mortality were observed between these two groups. Conclusion： BAI neoadjuvant chemotherapy was safe and effective, which can increase the complete resection rate of the tumor and did not increase the operative complications and mortality.

Tuberculous esophagomediastinal fistula with concomitant mediastinal bronchial artery aneurysm-acute upper gastrointestinal bleeding: A case report

BACKGROUND Esophagomediastinal fistula is a very rare complication of tuberculosis in otherwise healthy adults, and mediastinal bronchial artery aneurysm is even rarer. In this case report, we describe a rare case of tuberculosis complication that presented with acute upper gastrointestinal(GI) bleeding. It also highlights the benefits of chest computed tomography(CT) as an excellent adjunct diagnostic tool to endoscopy and bronchoscopy and the role of trans-arterial embolization as a minimal invasive therapy alternative to surgery.CASE SUMMARY A 19-year-old medically free male patient presented with acute multiple episodes of hematemesis for 1 d. Upper GI endoscopy, bronchoscopy, and chest CT with IV contrast confirmed esophagomediastinal fistula with mediastinal bronchial artery aneurysm. After resuscitating patient with IV fluid and blood product transfusion, trans catheter embolization was performed for mediastinal bronchial artery aneurysm.CONCLUSION We successfully treated a patient with acute upper GI bleeding due to tuberculous esophagomediastinal fistula and mediastinal bronchial artery aneurysm using transcatheter coil embolization.

Bronchial artery embolization in hemoptysis

Massive hemoptysis is one of the most dreaded of all respiratory emergencies and can have a variety of underlying causes. It is mostly caused by bleeding from bronchial circulation. Bronchial artery embolization is now considered to be the treatment of choice for acute massive hemoptysis. Bronchial artery embolization (BAE) is a safe and effective nonsurgical treatment for patients with massive hemoptysis. However, nonbronchial systemic arteries can be a significant source of massive hemoptysis and a cause of recurrence after successful BAE. So knowledge of the bronchial artery anatomy, together with an understanding of the pathophysiologic features of massive hemoptysis, are essential for planning and performing BAE in affected patients. In addition, interventional radiologists should be familiar with the techniques, results, efficacy, safety and possible complications of BAE and with the characteristics of the various embolic agents. Bronchial arterial catheterisation in human via a percutaneous approach has been practiced for 32 years (1973) in the world and 20 years (1986) in China, initially for direct chemotherapy treatment for bronchial malignancies and then for the embolization of patients with massive haemoptysis. A review of clinical experience to evaluate technique,embolic materials,outcome and complications of BAE is presented.

Coil embolization of bronchial artery aneurysm with high flow bronchial artery-pulmonary artery fistula

We report a case of an asymptomatic 36-year-old man with a bronchial artery aneurysm in the right hilum. Selective angiography revealed a 25mmsaccular aneurysm and an efferent artery of the aneurysm forming a high flow bronchial artery-pulmonary artery fistula. Because of dilatation and tortuosity of the bronchial artery, the microcatheter could reach the efferent artery but not the fistula. Therefore, we embolized the fistula by sending microcoils through the bloodstream from the efferent artery to the fistula (the “flow-dependent” coil embolization technique), and further embolized the aneurysm by coil isolation and packing technique.

Effect of preoperative bronchial artery infusion chemotherapy on the tumor malignancy of patients with stage IIIA non-small cell lung cancer

Objective:To investigate the effect of preoperative bronchial artery infusion chemotherapy on the tumor malignancy of patients with stage IIIA non-small cell lung cancer.Methods:99 patients with stage IIIA non-small cell lung cancer who underwent surgical treatment in our hospital between January 2015 and August 2018 were chosen as the research subjects, and the preoperative adjuvant therapies were reviewed and used to divide them into the control group (n=51) who received conventional neoadjuvant chemotherapy and the study group (n=48) who received neoadjuvant chemotherapy combined with bronchial artery infusion chemotherapy. The differences in the expression levels of NSCLC-related proliferation, invasion and apoptosis genes in intraoperative lesion tissues were compared between the two groups.Results: NSCLC-related proliferation genes CD137L, dlk1, EZH2 and WT1 mRNA expression in lesion tissues of study group were lower than those of control group whereas DCLAK11 mRNA expression was higher than that of control group;NSCLC-related invasion genes ALX1, periostin and RAC1 mRNA expression were lower than those of control group whereas DAL-1 mRNA expression was higher than that of control group;NSCLC-related apoptosis genes Survivin, Livin, bcl-2 and Bag-1 mRNA expression were lower than those of control group.Conclusion: Preoperative bronchial artery infusion chemotherapy can further inhibit the malignant biological behaviors of cancer cells in patients with stage IIIA NSCLC.

Assessment of the efficacy and safety of bronchial artery perfusion chemotherapy combined with high-frequency hyperthermia for advanced non-small cell lung cancer

Objective:To study the efficacy and safety of bronchial artery perfusion chemotherapy combined with high-frequency hyperthermia for advanced non-small cell lung cancer. Methods:Patients with advanced non-small cell lung cancer who were treated in Navy General Hospital between May 2014 and October 2016 were selected and randomly divided into two groups, the observation group received bronchial arterial infusion chemotherapy combined with high-frequency hyperthermia, and the control group received bronchial arterial infusion chemotherapy. Before and after treatment, the expression of tumor activity indexes and liver and kidney function indexes in serum as well as and proliferation and invasion genes in tumor lesions were detected respectively.Results: 5 d and 7 d after treatment, serum CEA, MIF, CYFRA21-1 and HE4 levels of both groups of patients were significantly lower than those before treatment and serum CEA, MIF, CYFRA21-1 and HE4 levels of observation group were significantly lower than those of control group;7 d after treatment, MEF2D, c-myc, Survivin, Bcl-2, Vimentin, N-cadherin and Slug expression in tumor lesions of both groups of patients were significantly lower than those before treatment and MEF2D, c-myc, Survivin, Bcl-2, Vimentin, N-cadherin and Slug expression in tumor lesions of observation group were significantly lower than those of control group;serum Scr, BUN, ALT and AST levels were not significantly different between two groups of patients before and after treatment. Conclusion:Bronchial artery perfusion chemotherapy combined with high-frequency hyperthermia for advanced non-small cell lung cancer can significantly inhibit the tumor proliferation and invasion and is with ideal safety.

Recurrent hemoptysis in pediatric bronchial Dieulafoy’s disease with inferior phrenic artery supply:A case report

BACKGROUND Bronchial Dieulafoy’s disease(BDD)is characterized by the erosion of an anomalous artery in the submucosa of the bronchus.The etiology of pediatric BDD is mainly congenital dysplasia of bronchus and pulmonary arteries,which is different from chronic inflammatory injury of the airway in adult patients.The internal thoracic artery,subclavian artery,and intercostal artery are known to be involved in the blood supply to the BDD lesion in children.CASE SUMMARY We report a case of BDD in a 4-year-old boy with recurrent hemoptysis for one year.Selective angiography showed a dilated right bronchial artery,and anastomosis of its branches with the right lower pulmonary vascular network.Bronchoscopy showed nodular protrusion of the bronchial mucosa with a local scar.Selective embolization of the bronchial artery was performed to stop bleeding.One month after the first intervention,the symptoms of hemoptysis recurred.A computed tomography angiogram(CTA)showed another tortuous and dilated feeding artery in the right lower lung,which was an abnormal ascending branch of the inferior phrenic artery(IPA).The results of angiography were consistent with the CTA findings.The IPA was found to be another main supplying artery,which was not considered during the first intervention.Finally,the IPA was also treated by microsphere embolization combined with coil interventional closure.During the one-year follow-up,the patient never experienced hemoptysis.CONCLUSION The supplying arteries of the bleeding lesion in children with BDD may originate from multiple different aortopulmonary collateral arteries,and the IPA should be considered to reduce missed diagnosis.CTA is a noninvasive radiological examination for the screening of suspected vessels,which shows a high coincidence with angiography,and can serve as the first choice for the diagnosis of BDD.

Bronchial Artery Embolization for Hemoptysis： A Retrospective Observational Study of 344 Patients

Background：Hemoptysis is a significant clinical entity with high morbidity and potential mortality.Both medical management （in terms of resuscitation and bronchoscopic interventions） and surgery have severe limitations in these patients population.Bronchial artery embolization （BAE） represents the first-line treatment for hemoptysis.This article discusses clinical analysis,embolization approach,outcomes and complications of BAE for the treatment of hemoptysis.Methods：A retrospective analysis of 344 cases,who underwent bronchial arteriography at Tianjin Haihe Hospital between 2006 and 2013.Several aspects of outcome were analyzed：Demographics,clinical presentation,radiographic studies,results,complications and follow-up of BAE.Results：Three hundred and forty-four consecutive patients underwent bronchial arteriography,336 of 344 patients （97.7%） performed BAE; there were 1530 coils for 920 arteries embolized; the main responsible sources for bleeding were right bronchial artery （29.7%）,left bronchial artery （21.6%）,combined right and left bronchial trunk （18.4%）,right intercostal arteries （13.3%）; 61 patients （17.7%） had recurrent hemoptysis within 1 month after undergoing BAE,74 patients （21.5%） had recurrent hemoptysis over 1 month after undergoing BAE; The common complications of BAE included subintimal dissection,arterial perforation by a guide wire,fever,chest pain,dyspnea,etc.The follow-up was completed in 248 patients,28 patients had been dead,21 patients still bleed,92 patients had lost to follow-up.Conclusions：The technique of BAE is a relatively safe and effective method for controlling hemoptysis.The complications of BAE are rare.Although the long-term outcome in some patients is not good,BAE may be the only life-saving treatment option in patients who are poor surgical candidates.

咯血患者甲状颈干异位支气管动脉解剖分析和栓塞治疗

目的分析咯血患者中起源于甲状颈干的异位支气管动脉解剖特点和栓塞治疗。方法回顾性分析2020年1月至2023年7月在湖州市中心医院接受支气管动脉栓塞术(BAE)治疗的连续565例咯血患者临床资料。所有患者BAE前均接受多层螺旋CT血管造影(MDCTA)检查,其中519例BAE期间同时行锁骨下动脉及其分支DSA检查。对发现起源于甲状颈干支气管动脉的解剖、影像学表现及BAE情况进行初次描述。结果21例患者中有22支起源于甲状颈干的异位支气管动脉。根据开口位置及血管走行,22支甲状颈干异位支气管动脉中13支(59.1%)为Ⅰ型,4支(18.2%)为Ⅱ型,4支(18.2%)为Ⅲ型,1支(4.5%)为Ⅳ型。有5支(22.7%)异位支气管动脉与其他支气管动脉交通。所有异位支气管动脉均经BAE栓塞成功,术后均未发生严重并发症。结论MDCTA联合锁骨下动脉及其分支DSA可显示起源于甲状颈干异位支气管动脉的解剖学特征。超选择性BAE栓塞此类支气管动脉安全有效。

孤立性支气管血管瘤致反复咯血1例

1临床资料患者女,26岁,因“反复咯血4个月,再发1 d”于2018年3月27日收入院。体格检查:体温36.5℃,脉搏92次/min,呼吸22次/min,血压124/64 mmHg(1 mmHg=0.133 kPa),血氧饱和度96%。神志清晰,双肺呼吸音粗,右肺可闻及湿性啰音,心率齐,无杂音。腹部平软,全腹无压痛及反跳痛。入院实验室检查:血红蛋白113 g/L、血小板计数229×10^(9)/L、凝血酶原时间10.8 s。

支气管动脉栓塞治疗大咯血的性别回顾分析

目的回顾性分析发生肺大咯血患者的临床特征和预后结局。方法收集2016年至2018年因大咯血在我院接受支气管动脉栓塞术的患者,按照性别差异分为2组,其中女性68例,男性195例;统计患者的原发病、发病年龄、住院时长、出血部位、使用的栓塞剂、咯血复发率及死亡率,使用SPSS 27.0软件分析患者发病年龄和住院时长、性别和患者复发咯血及死亡的相关性,使用RStudio 4.2.2制作患者复发咯血及死亡诺莫图。结果原发病前3位的细菌感染、支气管扩张(支扩)和陈旧性肺结核中女性发病率为50%、22%、15%,男性为43%、21%、21%;发病年龄女性为(54.6±16.8)岁,男性为(60.1±14.0)岁;出血部位中仅左肺、仅右肺、双肺可见,女性占比6%、21%、73%,男性占比17%、21%、62%;栓塞剂350~560μm PVA颗粒和300~500μm微球中女性31%、24%,男性50%、17%;复发咯血患者中前3位原发病陈旧性肺结核、肺部感染和支扩中,女性占比33%、33%、33%,男性44%、34%、10%;引起患者死亡的原因较为复杂,其中肺部感染起到了重要作用。结论女性和男性在原发病、出血部位、栓塞剂的适用、复发咯血和死亡预后当中存在性别差异,且年龄为患者复发咯血及死亡的独立影响因素。

特发性支气管扩张伴咯血患者的介入治疗疗效及复发危险因素分析

目的评估支气管动脉栓塞术治疗特发性支气管扩张伴咯血的安全性、有效性并探讨复发的危险因素。方法回顾性收集2020年1月至2023年3月金华市中心医院住院接受支气管动脉栓塞术治疗的108例特发性支气管扩张患者的临床资料,根据出院后是否出现二次咯血将其分为复发组和非复发组,并通过多因素Cox回归分析咯血复发的危险因素。结果108例患者均成功实施支气管动脉栓塞术,共发现403支责任血管。105例患者术后24 h止血,临床成功率为97.2%。出院后中位随访时间为13(8.0,24.8)个月,40例患者出院后咯血复发,咯血复发率为37.0%。多因素Cox回归分析显示,非首次咯血是术后复发的独立危险因素(HR=1.964,95%CI:1.018~3.792,P=0.044)。所有患者均未出现脑梗死、截瘫等严重并发症。结论支气管动脉栓塞术对于特发性支气管扩张伴咯血患者是一种安全、高效的治疗手段,非首次咯血是术后复发的独立危险因素。

支气管动脉栓塞术治疗大咯血的疗效观察

目的 观察支气管动脉栓塞术治疗大咯血的疗效。方法 选择大咯血患者227例作为观察对象,将患者随机分为介入手术组(行支气管动脉栓塞术治疗, 90例)和内科治疗组(单纯行内科止血治疗, 137例)。比较两组患者的治疗效果,不同时间咯血量。结果 介入手术组总有效率94.44%高于内科治疗组的81.02%,差异具有统计学意义(P<0.05)。治疗后1、4、7 d,介入手术组咯血量分别为(0.61±0.27)、(0.39±0.10)、(0.04±0.01)ml,均低于内科治疗组的(20.46±2.41)、(10.22±2.24)、(4.22±0.95)ml,差异具有统计学意义(P<0.05)。结论 运用支气管动脉栓塞术治疗大咯血,可提升疗效、降低咯血量,可运用。

支气管动脉化疗栓塞术的技术细节与进展综述

支气管动脉化疗栓塞术(bronchial arterial chemoembolization,BACE)是中晚期原发性肺癌标准治疗进展后较为成熟的局部微创姑息治疗技术,但其技术细节存在较多争议,难以标准化。通过文献复习,本文主要对肺癌血供来源,BACE使用的栓塞材料、栓塞材料的粒径大小,BACE治疗次数、栓塞终点、抗肿瘤药物的选择,以及BACE的并发症、治疗效果等进行综述。

支气管动脉灌注术和支气管动脉化疗栓塞术治疗肺癌的中国专家共识(2023版)

支气管动脉灌注术(bronchial arterial infusion,BAI)和支气管动脉化疗栓塞术(bronchial arterial chemoembolization,BACE)治疗肺癌从20世纪80年代应用于临床,尽管缺乏高级别循证医学证据,暂时未能列入肺癌治疗相关指南与规范,但因BAI/BACE有较好的客观反应率和比系统化疗低的不良反应发生率,其临床应用备受关注。鉴于此,本共识通过系统回顾国内外研究文献,并广泛征集国内同道的意见和建议,结合临床实践并充分讨论,对BAI/BACE治疗肺癌的理论依据,特别是肺癌血供研究成果、适应证、禁忌证、术前评估事项、术前准备、操作流程、疗效评估、综合治疗、并发症防治以及随访要求等方面基本达成一致。为开展BAI/BACE临床实践和研究提供参考依据和技术支持,以期更好地发挥其在肺癌综合治疗中的临床作用。

养肺益气汤联合载药微球支气管动脉化疗在非小细胞肺癌治疗中的临床效果分析

目的:分析养肺益气汤联合载药微球支气管动脉化疗治疗非小细胞肺癌的临床效果。方法:选择2020年1月—2023年1月启东市中医院肿瘤科收治的82例非小细胞肺癌患者,根据随机数表法分为化疗组、联用组,各41例。其中化疗组采用载药微球支气管动脉化疗治疗,而联用组采用养肺益气汤联合载药微球支气管动脉化疗治疗。比较两组肿瘤标志物、中医症候积分、毒副作用发生率。结果:治疗前,两组肿瘤标志物比较,差异无统计学意义(P>0.05);治疗后,两组肿瘤标志物均低于治疗前,且联用组低于化疗组,差异有统计学意义(P<0.05)。治疗前,两组中医症候积分比较,差异无统计学意义(P>0.05);治疗后,两组中医症候积分均低于治疗前,且联用组低于化疗组,差异有统计学意义(P<0.05)。联用组毒副作用总发生率低于化疗组,差异有统计学意义(P<0.05)。结论:在针对非小细胞肺癌进行治疗时,在载药微球支气管动脉化疗基础上予以养肺益气汤治疗能够进一步控制癌症病变,缓解各项临床症状,并降低毒副作用发生的可能性。