イシイ　テツコ   Ishii Tetsuko   石井　徹子    所属   医学部 医学科（東京女子医科大学病院）    職種   非常勤講師
言語種別	英語
発表タイトル	Successful treatment of primary racemose hemangioma of the bronchial artery using expandable hydrogel polymer coil
会議名	CSI Frankfurt 2017
主催者	The CSI Foundation
学会区分	国際学会及び海外の学会
発表形式	ポスター掲示
講演区分	一般
発表者・共同発表者	◎KOGURE Tomohito, SUGIYAMA Hisashi, ISHII Tetsuko, BOKU Hitomi, HAGIWARA Nobuhisa
発表年月日	2017/06/30
開催地 （都市, 国名）	Frankfurt, GERMANY
概要	A 2-year-old boy had recurrent hemoptysis and respiratory insufficiency and required long-term mechanical ventilation support for the repeated life-threatening hemoptysis. The chest X-ray showed consolidation shadows in the bilateral lower lobes. The enhanced CT showed numerous complex abnormal arteries on the surrounding of the carina and bilateral bronchus. Angiography revealed a complex, tortured and dilated bronchial arteries. Judging from his CT findings, primary racemose hemangioma of a bronchial artery was diagnosed. To prevent from recurrent hemoptysis and withdraw from mechanical ventilation, coil embolization for these lesions was planned. Catheter examination showed mean pulmonary artery pressure of 24 mmHg and pulmonary systemic blood flow ratio of 1.7. Angiography showed multiple plexus like abnormal vessels in the surrounding of the carina and bilateral bronchus. Left ventricular cavity was mildly dilated. Total 40 pieces of expandable hydrogel polymer coil and bare metal coil were implanted. Abnormal pulmonary blood flow remarkably decreased after coil embolization. Hemoptysis did not recur and his respiratory insufficiency improved immediately. He has shown a good clinical course without recurrent hemoptysis for 2 years since. DISCUSSION Racemose hemangioma is a rare vascular malformation, especially in children. Previous studies reported the coil embolization for racemose hemangioma was temporally effective, but the efficacy was limited in many cases because of plexus-like complex abnormal vessels, which connected each other. Most cases required lung lobectomy. Consequently, short-segmental embolization was considered to be not effective for prevention of hemoptysis. Furthermore, recurrent of hemoptysis after coil embolization was not rare in the racemose hemangioma because of recanalization. Therefore, we believed embolization for whole segment of abnormal vessels by non-recanalization material such as hydrogel material was essential. CONCLUSION Expandable hydrogel polymer coil has greater filling and mechanical stability and it could be effective against recanalization in racemose hemangioma.