Artery Embolization For Massive Hemoptysis Research Articles

The efficacy and safety of combined therapy with endobronchial tamponade and bronchial artery embolization for massive hemoptysis

BackgroundMassive hemoptysis is characterized by its life-threatening nature, potentially leading to airway obstruction and asphyxia. The objective of this study was to evaluate the clinical effectiveness of combining endobronchial tamponade with bronchial artery embolization (BAE) in the treatment of massive hemoptysis.MethodsBetween March 2018 and March 2022, a total of 67 patients with massive hemoptysis who underwent BAE were divided into two groups: the combination group (n = 26) and the BAE group (n = 41). Technical and clinical success rates were assessed, and adverse events were monitored following the treatment. Blood gas analysis and coagulation function indicators were collected before and after the treatment, and recurrence and survival rates were recorded during the follow-up period.ResultsAll patients achieved technical success. There were no significant differences in the clinical success rate, recurrence rates at 3 and 6 months, and mortality rates at 3 months, 6 months, and 1 year between the combination group and the BAE group. However, the hemoptysis recurrence rate at 1 year was significantly lower in the combination group compared to the BAE group (15.4% vs. 39.0%, P = 0.039). No serious adverse events were reported in either group. After treatment, the combination group showed higher levels of arterial partial pressure of oxygen (PaO2), oxygenation index (PaO2/FiO2), fibrinogen (FIB), and D-dimer (D-D) compared to the BAE group (P < 0.05). Multivariate regression analysis demonstrated a significant correlation between combined therapy and hemoptysis-free survival.ConclusionCombination therapy, compared to embolization alone, exhibits superior efficacy in improving respiratory function, correcting hypoxia, stopping bleeding, and preventing recurrence. It is considered an effective and safe treatment for massive hemoptysis.

Emergency artery embolization for massive hemoptysis due to invasive pulmonary aspergillosis in refractory acute myeloid leukemia—a case report

Emergency artery embolization for massive hemoptysis due to invasive pulmonary aspergillosis in refractory acute myeloid leukemia—a case report

EARLY SURGICAL INTERVENTION CAN BE NECESSARY: PERSISTENT MASSIVE HEMOPTYSIS DESPITE EMBOLIZATION AND BLOCKADE

SESSION TITLE: Critical Care 5 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Massive hemoptysis is a life-threatening condition due to the potential for asphyxiation or exsanguination. Commonly causes are bronchiectasis, bronchogenic carcinoma and infectious etiologies such as tuberculosis and pneumonia. Management involves localization of the bleeding source via bronchoscopy or computerized tomographic (CT) angiography with subsequent non-surgical or surgical intervention to control the bleeding. We present a case of massive hemoptysis secondary to bronchiectasis, unresponsive to bronchoscopic intervention and bronchial artery embolization (BAE), requiring definitive surgical lobectomy. CASE PRESENTATION: A 67-year-old male was admitted for evaluation of persistent hemoptysis in setting of moderate chronic obstructive pulmonary disease (COPD) and recent percutaneous biopsy of liver mass. Examination revealed rales in right lower lung base. CT of the thorax showed emphysematous changes with multiple blebs and lower-lobe honeycomb fibrotic thickening. Continued episodes of hemoptysis prompted bronchoscopic evaluation. Right lower lobe visualization revealed active bleeding from lateral and posterior segments. Despite epinephrine administration and iced saline lavage, bleeding persisted. Balloon tamponade with an endobronchial blocker was introduced into the right lower lobe and left in place. Interventional radiology consulted for arteriographic embolization. Balloon deflation after 24 hours revealed active persistent bleed. Cardiothoracic surgery was consulted and performed an emergent lobectomy. Gross pathology revealed no pleural disruption to support the notion that liver biopsy might have precipitated hemoptysis. Microscopy revealed reactive pneumocytes and significant airway ectasia. DISCUSSION: Angiography followed by BAE is the preferred management for massive hemoptysis in poor surgical candidates. In COPD both bronchiectatic and cryptogenic hemoptysis responds favorably to BAE. It has been reported as definitive treatment in both cystic and non-cystic fibrosis bronchiectasis. BAE is effective in controlling hemoptysis with success rates ranging from 70-90%. Recurrence rates vary from 10 to 57%.(1) Early recurrences occur secondary to lack of localization and inadequate embolization of all the feeding vessels. Despite high operative risks, our patient was managed with emergent lobectomy due to persistent bleeding. Emergent surgery in massive hemoptysis is associated with mortality rates up to 40%. BAE can be used as a bridge to stabilize patients before surgical treatment with an elective mortality rate 18%. (2) A retrospective analysis comparing the mortality and morbidity cohort of patients who underwent surgery after BAE vs those with early surgical intervention found no difference in outcomes.(3) CONCLUSIONS: Early surgical consultation is warranted for life-threatening massive hemoptysis in the setting of unsuccessful endobronchial blockade and BAE. Reference #1: Panda A, Bhalla AS, Goyal A. Bronchial artery embolization in hemoptysis: a systematic review. Diagn Interv Radiol. 2017;23(4):307-17. Reference #2: Fruchter O, Schneer S, Rusanov V, Belenky A, Kramer MR. Bronchial artery embolization for massive hemoptysis: long-term follow-up. Asian Cardiovasc Thorac Ann. 2015;23(1):55-60. Reference #3: Alexander GR. A retrospective review comparing the treatment outcomes of emergency lung resection for massive hemoptysis with and without preoperative bronchial artery embolization. Eur J Cardiothorac Surg. 2014;45(2):251-5. DISCLOSURES: No relevant relationships by Francis Christian, source=Web Response No relevant relationships by Sardar Ijaz, source=Web Response No relevant relationships by Kellie Jones, source=Web Response No relevant relationships by Erin Shirley, source=Web Response

Drainage of Cerebrospinal Fluid and Blood Pressure Augmentation as Rescue Therapies for Ischemic Myelitis After Bronchial Embolization: A Case Report.

A 62-year-old man presented to the emergency department with massive hemoptysis. After bronchial artery embolization, he developed ischemic myelitis, a rare complication in this setting for which no specific therapy is currently recommended. The symptoms were managed with lumbar drainage of cerebrospinal fluid and blood pressure augmentation therapy. To our knowledge, this is the first report of using lumbar drainage of cerebrospinal fluid and blood pressure augmentation in the treatment of anterior medullary ischemia after bronchial artery embolization for massive hemoptysis. The treatment was associated with neurological recovery.

Bronchial Artery Embolization with Large Sized (700-900µm) Tris-acryl Microspheres (Embosphere) for Massive Hemoptysis: Long-Term Results (Clinical Research).

To investigate the safety, efficacy and long-term results of bronchial artery embolization with microsphere particles (Embosphere® Microspheres, BioSphere Medical, Rockland, MA) 700-900µm in size for massive hemoptysis. One hundred and seventy-four patients (94 female, 80 male; mean age 39.4±5.7) who had bronchial artery embolization for massive hemoptysis between January 2010 and October 2015 were incorporated in the study. Patients had hemoptysis with a mean volume of 525±150mL (median 500mL, range 300-1200mL) over a 24-h period. Underlying pathologies included bronchial artery hypertrophy due to bronchiectasis (56.3% [98/174]), lung cancer (29.9% [52/174]), tuberculosis (10.3% [18/174]) and the rest remained idiopathic (3.4% [6/174]). Mean bronchial artery diameter before the intervention was 3.8±1.5mm (median 4mm, range 3.1-7.5mm). Median follow-up period was 56months (range 10-82months). Primary objectives were the technical and clinical success. Technical success was 100%. Clinical success for preventing massive hemoptysis was 91.9% (160/174). There was no procedure-related mortality or morbidities. Minor complications such as chest pain were observed in nine patients (5.0%). Recurrent hemoptysis (8.1%) was observed within 6months in 14 patients, ten of whom were treated with a second embolization session and the remaining four with a total of three embolization sessions. Bronchial artery embolization for massive hemoptysis with Embosphere particles 700-900µm in size is a safe and effective method with high technical and clinical success rates. Long-term results are excellent.

Bronchial artery embolization for massive hemoptysis: long-term follow-up.

Bronchial artery angiography with embolization has become a mainstay in the treatment of massive hemoptysis. Whereas the immediate success rate is high, the reported long-term success rate varies widely among different groups. We aimed to explore the long-term outcome and clinical predictors associated with recurrent bleeding following bronchial artery embolization. We reviewed the clinical characteristics, underlying etiologies, procedure details, and outcome of bronchial artery embolization performed for massive hemoptysis between 1999 and 2012. All 52 consecutive patients treated by bronchial artery embolization during the study period were included. The major etiologies of massive hemoptysis were bronchiectasis (mostly post-infectious) in 53.8%, and primary and metastatic lung cancer in 30.8%. The immediate success rate was high (48/52; 92%). Of 45 patients who survived more than 24 hours following bronchial artery embolization, recurrent bleeding did not occur in 19 (42.2%) during a median follow-up period of 60 months (range 6-130 months). Bleeding recurred in 26 (57.7%); within 30 days in 15 (33.3%) and after 1 month in the other 11 (24.4%). The average time to onset of early and late repeat bleeding was 2 and 506 days, respectively. Idiopathic bronchiectasis and lung cancer were associated with a high likelihood of late bleeding recurrence. Bronchial artery embolization is an effective immediate treatment for massive hemoptysis. Because the bleeding recurrence rate is high in patients with lung cancer or idiopathic bronchiectasis, surgery should be considered in these patients following initial stabilization by bronchial artery embolization. For other underlying etiologies, the long-term outcome is excellent.

Significance of nonbronchial systemic artery embolization for massive hemoptysis

Objective To emphasize the importance of embolization of nonbronchial systemic arteries in treatment of acute and life-threatening massive hemoptysis.Methods In a series of 146 patients with hemoptysis who underwent bronchial artery embolization,we found 12 cases whose blood supply were from 17 nonbronchial systemic arteries and hemoptysis was more than 300 ml blood within 24 hours.Embolic materials included absorbable gelatin sponge(GS),kelp micro gelatin(KMG),polyvinyl alcohol(PVA) particles and metal coils. Results In the 12 cases with 17 nonbronchial systemic arteries (4 were intercostal,3 internal mammary,3 thyrocervical trunk,3 inferior phrenic,1 left gastric,2 originated from the inferior aortic arch,and 1 originated from anterior abdominal aortic wall).Five cases were embolized by GS alone,2 cases by KMG,3 cases by GS+PVA,and 2 cases by GS+PVA+metal coils.Eight cases were performed embolization once,3 cases were performed twice and 1 case was performed three times.No significant complications developed related to embolization,except that 1 patient had transient eyesight decrease after embolization of thyrocervical trunk and 2 patients had chest pain after embolization of intercostal artery which resovled without any treatment.Conclusions During bronchial artery embolization for hemoptysis patients,all supplying artery should be searched and found.Even after successful embolization of bronchial arterys for hemoptysis patients,nonbronchial systemic arterial supply should still be taken into account. Key words: Bronchial arteries; Hemoptysis; Embolization,therapeutic

Bronchial Artery Embolization for Massive Hemoptysis

Bronchial Artery Embolization for Massive Hemoptysis

Utility of fiberoptic bronchoscopy before bronchial artery embolization for massive hemoptysis.

Utility of fiberoptic bronchoscopy before bronchial artery embolization for massive hemoptysis.

Utility of fiberoptic bronchoscopy before bronchial artery embolization for massive hemoptysis.

We wanted to investigate the utility of performing fiberoptic bronchoscopy before bronchial artery embolization in patients with massive hemoptysis. We retrospectively reviewed the cases of all patients with hemoptysis who had presented at either of two local hospitals, one county hospital and one community hospital, between 1988 and 2000 and who had undergone fiberoptic bronchoscopy before bronchial arteriography. All data were abstracted using a standardized coding form, and radiographs were independently reviewed by two of the authors. Twenty-nine patients meeting the inclusion criteria were identified; one patient was excluded because of missing radiographs. The remaining 28 patients consisted of 19 men and nine women, with an average age of 54.6 years (age range, 16-91 years). The clinically determined diagnoses of their symptoms were tuberculous bronchiectasis (n = 14; 50.0%); bronchogenic carcinoma (n = 4; 14.3%); active tuberculosis (n = 2; 7.1%); nontuberculous bronchiectasis (n = 2; 7.1%); active coccidioidomycosis, pancreaticobronchial fistula, arteriovenous malformation, and tetralogy of fallot (n =1 each; 3.6% each); and unknown cause (n = 2; 7.1%). The bleeding site determined through bronchoscopy was consistent with that determined through radiographs in 23 patients (82.1%); all had either unilateral disease (n = 15), bilateral disease with unilateral cavities (n = 5), or a preponderance of disease on one side (n = 3). Bronchoscopy was an essential tool in determining the bleeding site in only three patients (10.7%), all of whom had bronchiectasis without localizing features visible on chest radiographs. In the remaining two patients (7.1%), bronchoscopic findings were indeterminate, but radiographs were helpful. Fiberoptic bronchoscopy before bronchial artery embolization is unnecessary in patients with hemoptysis of known causation if the site of bleeding can be determined from radiographs and no bronchoscopic airways management is needed.

大量喀血例に対する気管支動脈 embolization の経験

大量喀血例に対する気管支動脈 embolization の経験

Bronchial artery embolization for massive hemoptysis

Bronchial artery embolization for massive hemoptysis

Bronchial Artery Embolization for Massive Hemoptysis

Improved angiographic techniques have proved that therapeutic embolization is effective in controlling massive hemorrhage in selected sites of the gastrointestinal tract and central nervous system. We have controlled massive hemoptysis in five cases with use of our improved techniques and bronchial artery embolization. Because mortality due to massive hemoptysis in both benign and malignant disease is high, therapeutic bronchial artery embolization is the preferable approach in some cases.