Highlights
- •During embolisation embolic microspheres could migrate from bronchial to pulmonary arteries
- •In advanced disease, anastomoses between bronchial and pulmonary artery could reach 800µm
- •Nontarget pulmonary embolisation might explain complications such as chest pain
Abstract
Labelled background
Haemoptysis is a life-threatening complication of cystic fibrosis (CF). One treatment
is bronchial artery embolisation (BAE) using embolic-microspheres (EMs). During BAE,
pulmonary arteries can be seen on digital subtracted angiography while iodine containing
contrast material injection is performed in the bronchial artery. This suggests that
EMs could go from bronchial to nontarget pulmonary arteries. The aim was to evaluate
if EMs could be found inside pulmonary arteries on lung explants after BAE in transplanted
CF patients.
Methods
Retrospective observational study including patients with CF who underwent lung transplantation
and had previously needed BAE. Clinical, chest CT angiography, and angiographic data
were reviewed from medical records. Pathology examination of lung explants was performed
to analyze the EMs anatomical localisation.
Results
Eight patients were included between 2013 and 2015, four males with a mean age of
29 (19-45) years. All patients had bronchial artery hypertrophy on CT and bronchial-to-pulmonary
artery shunting during BAE. On pathology examination, EM ≤800 µm were found in the
pulmonary arteries in all patients and were responsible for distal branch occlusions.
Two pulmonary infarcts were observed on CT angiography after BAE and confirmed histopathologically.
Conclusions
EM migration from the bronchial to pulmonary arteries is a common occurrence after
BAE in patients with advanced stage CF. Although BAE is a highly effective means of
controlling haemoptysis in CF, studies on the optimal particle size are needed to
preserve pulmonary artery circulation, because these results suggest that low size
EMs could lead to nontarget embolisation.
Keywords
Abbreviations:
BAE (Bronchial artery embolisation), CF (Cystic fibrosis), CT (Computed tomography), DSA (Digital subtraction angiography), EM (Embolic-microsphere), FEV1 (percent predicted forced expiratory volume in 1 second), LTx (Lung transplantation)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: May 01, 2022
Accepted:
April 19,
2022
Received in revised form:
April 19,
2022
Received:
November 15,
2021
Identification
Copyright
© 2022 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.
