Abstract：
BACKGROUND: Vessel injury is a common complication during balloon pulmonary angioplasty (BPA). For persistent hemoptysis, gelatin sponge embolization (GSE) is considered, but its impact on subsequent perfusion in embolized vessels remains unknown. This study explores the feasibility of revascularization in vessels post-GSE.
METHODS: We included 64 vessels from 50 patients with chronic thromboembolic pulmonary hypertension who experienced hemoptysis during BPA in 2012-2023. Twenty-four vessels were treated conservatively (conservative group), while 40 were treated with GSE for persistent hemoptysis or desaturation despite conservative treatment (GSE group). We assessed hemoptysis-related parameters, perfusion of injured vessels pre- and post-treatment, and hemodynamic parameters through multiple BPA sessions.
RESULTS: Hemoptysis resolved immediately after the procedure in 67% of patients, including 70% of those in the GSE group, and all cases resolved by the next day. Of 37 embolized vessels, 41% showed spontaneous perfusion improvement in subsequent sessions. BPA was reperformed in 22 embolized vessels, with 86% showing further improvement, resulting in 70% of all embolized vessels finally showing improvement in perfusion. In both groups, clinical and hemodynamic parameters significantly improved after BPA.
CONCLUSIONS: Perfusion of embolized vessels improved after GSE, suggesting that GSE is safe for the treatment of severe persistent hemoptysis after conservative treatment.
METHODS: We included 64 vessels from 50 patients with chronic thromboembolic pulmonary hypertension who experienced hemoptysis during BPA in 2012-2023. Twenty-four vessels were treated conservatively (conservative group), while 40 were treated with GSE for persistent hemoptysis or desaturation despite conservative treatment (GSE group). We assessed hemoptysis-related parameters, perfusion of injured vessels pre- and post-treatment, and hemodynamic parameters through multiple BPA sessions.
RESULTS: Hemoptysis resolved immediately after the procedure in 67% of patients, including 70% of those in the GSE group, and all cases resolved by the next day. Of 37 embolized vessels, 41% showed spontaneous perfusion improvement in subsequent sessions. BPA was reperformed in 22 embolized vessels, with 86% showing further improvement, resulting in 70% of all embolized vessels finally showing improvement in perfusion. In both groups, clinical and hemodynamic parameters significantly improved after BPA.
CONCLUSIONS: Perfusion of embolized vessels improved after GSE, suggesting that GSE is safe for the treatment of severe persistent hemoptysis after conservative treatment.
摘要：
背景：血管损伤是球囊肺血管成形术（BPA）过程中常见的并发症。对于持续性咯血，明胶海绵栓塞（GSE）被认为，但其对栓塞血管随后灌注的影响尚不清楚。本研究探讨了GSE后血管血运重建的可行性。
方法：我们纳入了2012-2023年在BPA期间发生咯血的50例慢性血栓栓塞性肺动脉高压患者的64条血管。对24条血管进行保守治疗（保守组），尽管保守治疗，但仍有40人接受GSE治疗持续咯血或去饱和（GSE组）。我们评估了咯血相关参数，治疗前后损伤血管的灌注，和血液动力学参数通过多个BPA会话。
结果：67％的患者在手术后咯血立即消失，包括GSE组中70%的人，所有案件都在第二天解决。在37条栓塞血管中，41%的患者在随后的疗程中表现出自发灌注改善。在22条栓塞血管中重新进行了BPA，86%的人表现出进一步的改善，导致总共70％的栓塞血管最终显示灌注改善。在这两组中,BPA后临床和血流动力学参数明显改善。
结论：GSE后栓塞血管灌注改善，提示GSE对于保守治疗后严重持续性咯血的治疗是安全的。
方法：我们纳入了2012-2023年在BPA期间发生咯血的50例慢性血栓栓塞性肺动脉高压患者的64条血管。对24条血管进行保守治疗（保守组），尽管保守治疗，但仍有40人接受GSE治疗持续咯血或去饱和（GSE组）。我们评估了咯血相关参数，治疗前后损伤血管的灌注，和血液动力学参数通过多个BPA会话。
结果：67％的患者在手术后咯血立即消失，包括GSE组中70%的人，所有案件都在第二天解决。在37条栓塞血管中，41%的患者在随后的疗程中表现出自发灌注改善。在22条栓塞血管中重新进行了BPA，86%的人表现出进一步的改善，导致总共70％的栓塞血管最终显示灌注改善。在这两组中,BPA后临床和血流动力学参数明显改善。
结论：GSE后栓塞血管灌注改善，提示GSE对于保守治疗后严重持续性咯血的治疗是安全的。
