Patients Who Presented Systemic Air Embolism After Percutaneous Lung Biopsy Under CT Guidance Depicted at the Time of the Procedure on a Whole Thoracic CT Clinical Trial
Official title:
Systemic Air Embolism After CT-guided Lung Biopsy: Incidence and Risk Factors Assessment
Systemic air embolism is traditionally considered as an extremely rare complication of
percutaneous lung biopsy. Current literature includes mainly case reports or small case
series of SAE. Majority of cases resulted in cardiac and/or neurological symptoms, often
causing death. In most reported cases, the diagnosis of systemic air embolism referred to
clinical manifestations without radiological diagnosis at the time of the procedure. Hence,
its incidence might be underestimated in case of asymptomatic patients. Immediate recognition
of air embolism during the procedure has been reported as the main factor to minimize severe
complications since specific management of patient can be initiated earlier.
The purpose of this study is to retrospectively assess the incidence of systemic air embolism
depicted at the time of the procedure on a whole thoracic CT, systematically performed after
transthoracic lung biopsy in a large cohort of consecutive patients. Secondary objectives are
to determine possible influencing factors and to evaluate clinical outcomes.
In this retrospective cohort study, all consecutive lung biopsies performed between April
2014 to May 2016 at our department of cardiothoracic interventional radiology were included
using the local thoracic biopsy database. Biopsies were scheduled after the weekly
multidisciplinary lung cancer meeting approval. Pleural, parietal and mediastinal lesions
were excluded due to the absence of intra-parenchymal pathway. Radiofrequency ablation and
peripheral nodule marking procedure were also excluded.
A complete retrospective imaging review of the procedures was performed on a PACS workstation
by an experienced chest radiologist. Clinical data was also collected from the electronic
medical record system.
Variables analyzed were age, sex, spirometry data, emphysema on CT, therapeutics previously
done, target lesion characteristics (location, depth, and nodule size and feature), patient
position, length of intrapulmonary biopsy path, number of pleural needle passes, biopsy
length and number of biopsy passes. Procedural air embolism and other associated
complications (hemoptysis and pneumothorax) and their management and consequences (length of
hospitalization and additional action) were recorded.
Patient's characteristics with and without air embolism were compared using Student or
Wilcoxon rank test for continuous variables and Chi-square or Fisher test for categorical
ones. To determine the relative importance of air embolism occurrence influencing factors,
multivariate logistic regression analysis was performed on variables according to
significance level or clinical coherence. A backward selection was used; the α-to-enter and
the α-to-exit were set, respectively, at 0.20 and 0.10. Statistical bilateral significance
threshold was set at 5%. Statistical analyses were performed using SAS version 9.1 (SAS
Institute, Cary, North Carolina).
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