| Objective: To investigate the efficacy of selective arterial embolization(SAE)in the treatment of patients with hemoptysis due to bronchiectasis,and to analyze the related factors of hemoptysis recurrence.Methods: A total of 53 patients with bronchiectasis and hemoptysis treated in our hospital from March 2016 to January 2017 were collected,and SAE was performed on all patients.The operation situation,postoperative hemostasis rate,related complications and the number and source of responsible vessels and angiographic manifestations were record.Kaplan-Meier test and Cox regression model were used to analyze the influencing factors of hemostasis rate after intervention.Results: All 53 patients successfully underwent SAE.A total of 136 hemoptysis arteries was embolized,1 to 5 in each case,including 1 in 7 cases,2 in 19 cases,3 in 18 cases,4 in 8 cases and 5 in 1 case.Of the 136 diseased vessels,92(67.6%)were bronchial artery(BA),and 44(32.4%)were non-bronchial systemic arteries(NBSA).The former included left BA 30(22.1%),right BA 45(33.1%),and left and right co-existing BA 17 Branches(12.5%),the latter specifically include 27 intercostal arteries(19.9%),12 internal thoracic arteries(8.8%),2 branches of the carotid artery(1.5%),2 branches of the iliac artery(1.5%),One lateral chest artery(0.7%).The direct signs of the responsible blood vessel are contrast medium overflow,and the indirect signs are thickening and tortuosity of the arterial trunk,bronchial artery-pulmonary shunt,and increased,dilated,and disordered distal small blood vessels.Twenty-five patients were treated with gelatin sponge particles and 28 patients were treated with polyvinyl alcohol(PVA)particles.Fifty-one patients had hemostasis immediately afterembolization.The hemostatic rate was 96.2%(51/53),and hemoptysis was reduced in 2patients(the number of responsible blood vessels was 3 and 4 respectively,all of which were severe bronchiectasis).No patient had severe complications such as paraplegia,and 5 patients had chest pain of varying degrees,which was relieved after symptomatic treatment.The 51 patients with successful hemostasis were followed up for 2 to 31 months,with a median follow-up time of 25 months.During the follow-up period,a total of 11 patients had recurrence of hemoptysis with a recurrence rate of 21.6%(11/51),of which 6 patients received SAE treatment again,and no hemoptysis recurrence occurred at the end of the follow-up.The cumulative hemostasis rates for the first stage of half year,1 year,and 2 years were 98.0%,96.1%,and 81.8%,and the cumulative hemostasis rates for the second stage were 98.0%,98.0%,and 93.9%.Univariate analysis showed no significant difference in hemostatic rate between patients of different genders and ages(P>0.05).The hemostatic rate of patients with different number of embolic vessels,grades of bronchiectasis,and embolic material was statistically significant(P<0.05).Cox multivariate analysis showed that the number of diseased blood vessels,grade of bronchiectasis,and embolic material were independent influencing factors of hemostasis rate after intervention(P<0.05).Conclusion: SAE is safe and effective in treating patients with bronchiectasis and hemoptysis,and has a good mid-term and long-term hemostasis rate.NBSA is an important source of hemoptysis in patients with bronchiectasis,and its thorough embolization can help ensure efficacy and reduce recurrence.The number of diseased blood vessels,grade of bronchiectasis,and embolic material were independent influencing factors of hemostasis rate after intervention. |
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