急诊经肱动脉入路行胸廓内动脉栓塞术治疗大咯血

目的探讨经肱动脉入路行胸廓内动脉(ITA)急诊栓塞治疗大咯血的疗效。方法回顾性分析13例经肱动脉入路行ITA栓塞术治疗大咯血的临床资料。选用明胶海绵条、聚乙烯醇(PVA)颗粒及弹簧圈选择性栓塞出血的动脉,对动脉造影的表现及治疗结果进行总结及评价。结果 13例患者共找到并成功栓塞13支病变的ITA。经股动脉入路选择失败的原因:6例因锁骨下动脉扭曲严重,7例因ITA开口变异。出血动脉造影主要表现为增粗,分支增多、紊乱及新生血管形成。3例患者栓塞止血后行病变肺叶切除术。所有患者术后随访1年均无再次咯血。结论对于怀疑有ITA出血但经股动脉入路选择困难的大咯血患者,肱动脉入路可作为很好的技术补充手段。

Emergency internal thoracic artery embolization in treatment of massive hemoptysis by brachial artery approach

Objective To explore the curative effect of emergency internal thoracic artery embolization in treatment of massive hemoptysis by brachial artery approach. Methods The clinical data of 13 patients of massive hemoptysis underwent emergency internal thoracic artery embolization by brachial artery approach were retrospectively analyzed. The bleeding arteries were embolized by embolic agents such as gelatin sponge, polyvinyl alcohol (PVA) particles and coils. The arteriographic manifestations and effect of the treatment for massive hemoptysis were analyzed. Results Thirteen bleeding internal thoracic artery were located and embolized successfully in 13 patients. Reasons for the failure of the femoral artery approach were grave twisted subclavian artery in 6 patients and variation opening of internal thoracic artery in 7 paitents. Selective arteriography demonstrated enlarged bleeding arteries, numerous and disorder branches and hypervascularity. Pulmonary lobectomy was performed in 3 patients after hemostasis of embolotherapy. After 12-month following-up, all patients had no recurrence haemoptysis after the embolotherapy. Conclusion For the patients with massive hemoptysis were suspected of the internal thoracic artery bleeding, brachial artery approach is a very good technique to replace the femoral artery approach.