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Clinical characteristics and postoperative outcomes of systemic artery-to-pulmonary vessel fistula in hemoptysis patients

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Abstract

Objectives

To investigate the clinical characteristics and outcomes on the success of bronchial arterial embolization (BAE) in patients with and without systemic artery-to-pulmonary vessel fistula (SA-PF) and to evaluate the feasibility of CTA in the assessment of SA-PF.

Methods

We retrospectively enrolled 420 consecutive patients that underwent BAE for hemoptysis control in our hospital from September 2011 to May 2019. The clinical characteristics, preprocedural CTA findings, BAE procedural findings, and follow-up outcomes were collected. Patients were divided into two groups according to DSA findings: patients with SA-PF and those without.

Results

A total of 184 (43.7%) patients presented with SA-PF. Pneumonia was less likely to be the concomitant condition in patients with SA-PF (p < 0.001). The mean number of culprit arteries per patient was significantly higher in patients with SA-PF compared to that in patients without SA-PF (p = 0.017). The SA-PF patients saw a greater probability of recurrence (HR: 2.782, 95% CI: 1.617–4.784, p < 0.001). SA-pulmonary venous fistula (SA-PVF) favored lower hemoptysis recurrence rate (HR: 0.199, 95%CI: 0.052–0.765, p = 0.019). SA-pulmonary artery fistula (SA-PAF) can be detected by optimized CTA protocol with a detection rate of 65.3% (49/75).

Conclusions

The presence of SA-PF is an independent risk factor predicting early recurrence of hemoptysis after BAE. SA-PVF seems to be a protective factor for longer hemoptysis control compared to SA-PAF. Optimized preprocedural CTA is a reliable examination to identify SA-PAF.

Key Points

• The appearance of SA-PF is associated with a greater probability of early recurrent hemoptysis after bronchial artery embolization.

• The presence of SA-PVF seems to be a protective factor for longer hemoptysis control after BAE compared to SA-PAF.

• Optimized CTA protocol seems to be a promising auxiliary examination to detect SA-PAF.

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Abbreviations

BA:

Bronchial artery

BAE:

Bronchial artery embolization

CTA:

Computerized tomography angiography

DSA:

Digital subtraction angiography

NBSA:

Non-bronchial systemic arteries

PA:

Pulmonary artery

PV:

Pulmonary vein

PVA:

Polyvinyl alcohol particles

SA-PAF:

Systemic artery-to-pulmonary artery fistula

SA-PF:

Systemic artery-to-pulmonary vessel fistula

SA-PVF:

Systemic artery-to-pulmonary venous fistula

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Funding

This study has received funding from the 1·3·5 Project for Disciplines of Excellence, Clinical Research Incubation Project (18HXFH036), West China Hospital, Sichuan University.

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Author notes

  1. Chu-Jie Zhang, Fa-Ming Jiang, and  Ze-Jin Zuo contributed  equally to this work.

Authors and Affiliations

  1. Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Sichuan Province, #37 Guo Xue Xiang, Chengdu, 610041, China

    Chu-Jie Zhang, Fa-Ming Jiang, Yue-An Zhao, Pei-Jun Li, Dong-Fan Ye, Lan-Lan Zhang, Feng-Ming Luo & Ye Wang

  2. Center of Interventional Radiology, West China Hospital, Sichuan University, Chengdu, China

    Fa-Ming Jiang & Ye Wang

  3. Institutional Review Board, West China Hospital, Sichuan University, Chengdu, China

    Ze-Jin Zuo

  4. Department of Intensive Care Unit, Karamay Municipal People’s Hospital, Karamay, China

    Shan-Shan Li, Hai-Ming Li & Ye Wang

  5. Department of Respiratory and Critical Care Medicine, Fourth Affiliated Hospital, Xinjiang Medical University, Urumqi, China

    Li-Hong Tong

  6. Department of Respiratory and Critical Care Medicine, Pangang Group General Hospital, Panzhihua, China

    Song-Lin Chen

Authors
  1. Chu-Jie Zhang
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Corresponding authors

Correspondence to Feng-Ming Luo or Ye Wang.

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Guarantor

The scientific guarantor of this publication is Ye Wang.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Methodology

• retrospective.

• observational.

• performed at one institution.

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Zhang, CJ., Jiang, FM., Zuo, ZJ. et al. Clinical characteristics and postoperative outcomes of systemic artery-to-pulmonary vessel fistula in hemoptysis patients. Eur Radiol 32, 4304–4313 (2022). https://doi.org/10.1007/s00330-021-08484-7

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  • DOI: https://doi.org/10.1007/s00330-021-08484-7

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