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Angiographic and histopathological study on bronchial-to-pulmonary vascular anastomoses on explants from patients with cystic fibrosis after bronchial artery embolisation

  • Author Footnotes
    1 Contributed equally to this work
    Paul Habert
    Correspondence
    Corresponding author informations: Dr Paul Habert, Assistance Publique - Hôpitaux de Marseille, Marseille, Provence-Alpes-Cote dAzu, France, Hôpital Nord, 15 chemin des Bourrely, 13015. Fax: +33413429066 Phone number: +33491964656
    Footnotes
    1 Contributed equally to this work
    Affiliations
    Imaging Department, Hopital Nord, APHM, Aix Marseille University

    Aix Marseille Univ, LIIE, Marseille, France

    Aix Marseille Univ, CERIMED, Marseille, France
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  • Author Footnotes
    1 Contributed equally to this work
    Basile Puech
    Footnotes
    1 Contributed equally to this work
    Affiliations
    Imaging Department, Hopital Nord, APHM, Aix Marseille University
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  • Benjamin Coiffard
    Affiliations
    Service de Pneumologie et équipe de transplantation pulmonaire, Centre de Ressources et de Compétences de la Mucoviscidose (CRCM) Adulte, AP-HM Hôpital Nord,13015, Marseille France

    Aix Marseille Université, Service de radiologie, La Timone Hôpital, 264 rue Saint Pierre, 13005 Marseille
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  • Véronique Secq
    Affiliations
    Service d'anatomie et cytologie pathologiques, Hôpital Nord, chemin des Bourrely, 13015 Marseille, France

    U1068- CRCM, Aix Marseille université, 13015 Marseille, France
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  • Pascal Thomas
    Affiliations
    Service de chirurgie thoracique et Transplantation Pulmonaire, hôpital Nord, chemin des Bourrely, 13015 Marseille, France

    Aix Marseille Université, Service de radiologie, La Timone Hôpital, 264 rue Saint Pierre, 13005 Marseille
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  • Romain Bec
    Affiliations
    Imaging Department, Hopital Nord, APHM, Aix Marseille University
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  • Vincent Vidal
    Affiliations
    Aix Marseille Univ, LIIE, Marseille, France

    Aix Marseille Univ, CERIMED, Marseille, France

    Aix Marseille Univ, APHM, INSERM, IRD, SESSTIM, ISSPAM, Hop Timone, Biostatistics department, BIOSTIC, Marseille, F-13005, France
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  • Julien Mancini
    Affiliations
    Aix Marseille Univ, APHM, INSERM, IRD, SESSTIM, ISSPAM, Hop Timone, Biostatistics department, BIOSTIC, Marseille, F-13005, France
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  • Julien Bermudez
    Affiliations
    Service de Pneumologie et équipe de transplantation pulmonaire, Centre de Ressources et de Compétences de la Mucoviscidose (CRCM) Adulte, AP-HM Hôpital Nord,13015, Marseille France
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  • Martine Reynaud-Gaubert
    Affiliations
    Service de Pneumologie et équipe de transplantation pulmonaire, Centre de Ressources et de Compétences de la Mucoviscidose (CRCM) Adulte, AP-HM Hôpital Nord,13015, Marseille France
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  • Jean-Yves Gaubert
    Affiliations
    Aix Marseille Univ, LIIE, Marseille, France

    Aix Marseille Univ, CERIMED, Marseille, France

    Aix Marseille Univ, APHM, INSERM, IRD, SESSTIM, ISSPAM, Hop Timone, Biostatistics department, BIOSTIC, Marseille, F-13005, France
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  • Author Footnotes
    1 Contributed equally to this work

      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)
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