Control Of Massive Hemoptysis Research Articles

Fungus ball removal with video-cavernoscopy for complex aspergilloma.

Complete resection with a clear margin is the only curative treatment for pulmonary aspergilloma. This requires a high-level technique, especially for complex aspergilloma (CA), because of patient conditions and wide dense adhesions. Fungus ball removal is used palliatively to control hemoptysis, rather than as a radical procedure, and may be performed using video-cavernoscopy as a simple and repeatable method. In this study, we examined this approach as an alternative treatment for CA. Eight cases of fungus ball removal with video-cavernoscopy (video-cavernoscopic removal) treated at our center were retrospectively reviewed. The patient characteristics and surgical outcomes were compared with those of patients treated with one-stage radical surgery. There were 8 subjects (7 males, 1 female; median age 65 years) in the video-cavernoscopic removal group and 25 subjects (19 males, 6 females; median age 56 years) in the one-stage radical surgery group. The video-cavernoscopic removal group had a higher rate of emphysematous lung (p = 0.001), a lower body mass index (p = 0.039), and a lower percent vital capacity (p = 0.027). All cases in this group had preoperative hemoptysis that ceased after the procedure. Video-cavernoscopic removal was less invasive based on a shorter operative time (p = 0.000), less blood loss (p = 0.002), and a lower Common Terminology Criteria for Adverse Events grade (p = 0.023). However, four cases in this group (50%) relapsed with a median disease-free survival period of 471.5 days. Fungus ball removal with video-cavernoscopy is a simple technique for the prevention and control of massive hemoptysis that may be an alternative treatment for CA.

Outcomes and safety of bronchial artery embolization in control of massive hemoptysis

BackgroundThe most frequent causes of massive hemoptysis are bronchiectasis, myecetoma, tuberculosis, bronchial carcinoma, and cryptogenic hemoptysis.ObjectiveThis study aimed to investigate the outcomes, safety, and complications of bronchial artery embolization (BAE) in the management of massive hemoptysis.Patients and methodsThis study included 32 patients who presented with massive hemoptysis who were indicated for BAE. The following data were obtained from each patient: detailed history, clinical examination, chest radiograph, computed tomography pulmonary angiography, fiberoptic bronchoscopy, and BAE.ResultsFifteen patients underwent BAE as an urgent procedure for control of massive hemoptysis and 17 patients underwent BAE as an elective procedure. The complications of BAE were fever in four patients (12.5%), back pain in three (9.38%), failure of BAE in two (6.25%), recurrence of hemoptysis in one (3.13%), and no mortality. BAE was successful in 30 out of 32 (93.75%) cases. Failure of catheterization was encountered in one (3.13%) case because of dissection during negotiations; therefore, no catheterization was performed. The second (3.13%) case showed extensive bronchial–pulmonary shunt with severe lung destruction, so that the procedure was deemed futile. After the procedure, immediate control of hemoptysis was achieved in 29 (90.62%) patients.ConclusionBAE can be used safely and effectively for control of massive hemoptysis; it can be used as an alternative nonsurgical option along with medical treatment or as a bridge to stabilize the patient until definitive surgical management can be performed. BAE can be considered an alternative to surgery if the patient is not fit for surgical intervention.

Occlusion with Endobronchial Watanabe Spigot for the management of critical patients with massive hemoptysis

Objective: Mortality rates for massive hemoptysis range from 7.1% to 18.2%. With the endobronchial Watanabe Spigot (EWS) in the control of massive hemoptysis, lober occlusion may be preferred in the first stage of emergency treatment. In this study, we evaluated the efficacy and complications of massive hemoptysis control by discussing the results of EWS using 22 consecutive massive hemoptysis case. Methods: This study included patients admitted to the intensive care unit due to massive hemoptysis and underwent EWS with rigid bronchoscopy under general anesthesia. Complications during and after the procedure were recorded, and the efficacy of the method was evaluated. Results: Mean age was 56.5±11.7 years. A patient who suffered massive bleeding due to failed intervention went to lobectomy. Mean duration of hospitalization was 11.7 days. In three cases with hemoptysis control, migration of EWS was observed on postoperative 4-11. days. One patient was exposed the spigot on day 50 and the other patient on day 8. Lobectomy was performed in a patient with a right upper apical segment. Age, gender distribution, length of stay, spigot number, survival time, smoking status, diagnosis and treatment success did not differ significantly in patients with and without complications (p ˃ 0.05). Conclusion: Lobular occlusion with EWS in massive hemoptysis control may be preferred in the first stage of emergency treatment, particularly in patients with tuberculosis or surgically inoperable massive hemorrhage. It is accepted as a safe and effective practice in order to avoid the risks of major surgery.

Cause of massive hemoptysis in critical patients and the effect of bronchial artery embolization

To investigate the cause of massive hemoptysis in critical patients, and to evaluate the effect of bronchial artery embolization (BAE) on critical patients with massive hemoptysis. A retrospective controlled analysis was conducted. The clinical data of 35 patients with life-threatening massive hemoptysis admitted to intensive care unit (ICU) of the First Hospital Affiliated to Guangzhou Medical University from January 2009 to December 2017 were analyzed. The patients were divided into BAE and non-BAE group according to whether receiving BAE or not. BAE patients were subdivided into subgroups: hemoptysis after ventilation and hemoptysis before ventilation subgroups, as well as survival and non-survival subgroups. The etiology of all massive hemoptysis was analyzed. The gender, age, acute physiology and chronic health evaluation II (APACHE II) score, amount of hemoptysis, whether presence of pleural thickening in chest CT, the length of ICU stay, total length of hospital stay, the duration of mechanical ventilation (MV), clinical effective and prognostic indicators of patients were recorded. The correlation between variables was analyzed by Spearman correlation analysis. All 35 patients were enrolled in the finally analysis. The main cause of critical patients with massive hemoptysis was fungal infection [37.1% (13/35)], followed by pneumonia and abnormal coagulation [17.1% (6/35)], bronchiectasis [11.4% (4/35)], tumor [8.6% (3/35)], etc. In all 35 patients, 27 were treated with BAE and 8 were treated without BAE. There was no difference in gender, age, the length of ICU stay, total length of hospital stay, the duration of MV, amount of hemoptysis, APACHE II score, whether use antiplatelet agents or anticoagulants, or whether presence of pleural thickening in chest CT between the two groups. The rate of hemoptysis remission in BAE group was significantly higher than that of non-BAE group [92.6% (25/27) vs. 25.0% (2/8), P < 0.01], but there was no statistically significant difference in hospital survival as compared with that of non-BAE group [48.1% (13/27) vs. 25.0% (2/8), P > 0.05]. Subgroup analysis showed that 64.3% (9/14) of patients with hemoptysis after ventilation was caused by pulmonary fungal infection, which was significantly higher than those with hemoptysis before ventilation [15.4% (2/13), P = 0.018]. Compared with hemoptysis after ventilation group, the length of ICU stay and the duration of MV in hemoptysis before ventilation group were significantly shortened [the length of ICU stay (days): 12.0 (14.0) vs. 30.0 (81.8), the duration of MV (days): 10.0 (16.0) vs. 25.0 (68.3)], the patients using antiplatelet drugs or anticoagulant drugs was decreased significantly (case: 1 vs. 9, all P < 0.05). However, there was no statistically significant difference in gender, age, total length of hospital stay, amount of hemoptysis, APACHE II score, whether presence of pleural thickening in chest CT, the rate of hemoptysis remission, the incidence of secondary BAE or hospital survival rate between the two groups. Compared with the survival subgroup (n = 13), more patients in the non-survival subgroup (n = 14) were treated with antiplatelet or anticoagulants (P < 0.05); and Spearman correlation analysis showed that the survival of the patients with BAE was negatively correlated with the use of antiplatelet or anticoagulants (r = -0.432, P = 0.024). There was no significant difference in the gender, age, the length of ICU day, total length of hospitalization, duration of MV, estimated hemoptysis, APACHE II score, or the proportion of pleural thickening between the two groups. The study indicated that the etiology of massive hemoptysis in critical patients was complicated. Fungal infection was the main cause in patients with hemoptysis after ventilation. BAE was effective in the control of massive hemoptysis in ICU, but it was not ideal for patients with abnormal coagulation function or abnormal platelet count or platelet dysfunction from antiplatelet or anticoagulant drugs, the overall survival rate was still low.

Risk Factors Influencing Rebleeding after Bronchial Artery Embolization on the Management of Hemoptysis Associated with Pulmonary Tuberculosis

BackgroundHemoptysis due to pulmonary tuberculosis (TB) frequently develops in Korea where the prevalence of TB is intermediate. The effect of bronchial artery embolization (BAE) on the control of massive hemoptysis has been well known. This study is designed to identify the risk factors contributing to rebleeding after BAE in patients with TB.MethodsWe retrospectively evaluated risk factors and the time for rebleeding after BAE in 72 patients presenting with hemoptysis.ResultsThe overall immediate success rate of BAE was 93.1% (67 of 72 patients). Of the 29 patients (40.3%) who showed rebleeding after BAE, 13 patients experienced rebleeding within 1 month, and 14 patients between 1 month to 1 year. The existence of a shunt in angiographic finding, aspergilloma, and diabetes mellitus were risk factors of rebleeding after BAE in multivariate analysis.ConclusionBAE was very effective for obtaining immediate bleeding control in hemoptysis associated with active TB or post-TB sequelae. It is important to observe whether or not rebleeding occurs up to 1 year of BAE especially in TB patients with aspergilloma, DM, or a shunt. Even rebleeding can be managed well by second BAE.

Transcatheter arterial embolization for massive hemoptysis in patients with coal workers' pneumoconiosis: an 11-year experience

Transcatheter arterial embolization (TAE) is a safe and well-established treatment option to control hemoptysis, but there are few studies focused on treating hemoptysis accompanying coal workers' pneumoconiosis (CWP). To evaluate the immediate and long-term efficacy of TAE for control of massive hemoptysis in patients with CWP, and to clarify the factors which influence the frequency of rebleeding. This study included 34 CWP patients with massive hemoptysis who were treated with 47 TAE sessions over the last 11 years. Immediate (within 1 month) and long-term outcomes (mean 37 months, range 1 month-11 years) were evaluated retrospectively. The relationships between the frequency of rebleeding and the type of CWP, angiographic findings, and presence of tuberculosis were evaluated. The immediate success rate was 91.2% (31/34). In 23 patients (68%), hemoptysis did not recur on long-term follow-up. In eight patients who received repeated procedures for recurrent hemoptysis, bleeding was discovered in the non-bronchial systemic artery (n = 13) or bronchial artery (n = 7). The frequency of recurrent hemoptysis was higher in cases with complicated pneumoconiosis (n = 7) than in cases of the simple type (n = 1; P = 0.029). There was no statistical difference between rebleeding and angiographic findings or the presence of tuberculosis. TAE is an effective treatment modality for controlling massive hemoptysis in patients with CWP. However, many non-bronchial systemic collaterals contribute to recurrent hemoptysis. Furthermore, there is a high probability of rebleeding in patients with the complicated type of CWP, and extra care must be taken in the embolization procedure.

Survival After Bronchial Artery Embolization in Massive Hemoptysis

Massive hemoptysis is a life-threatening event that requires emergency treatment. The aim of this study was to assess the effects of bronchial artery embolization on survival in cases of massive hemoptysis. This prospective study included 24 consecutive patients with massive hemoptysis who were treated with catheterization and embolization of the bronchial arteries. Assessments at 24 hours, 30, 120, and 180 days were performed. Nine cases of multidrug-resistant tuberculosis, six of bronchiectasis, four of lung cancer, and five with diverse pathology were treated. Three patients died of hemoptysis within the following 24 hours, two at 10 days, one at 33 days, and one at 120 days; another patient died of pneumonia. Bleeding was controlled in 16 cases at 180 days. Four patients were subjected to lung resection. Kaplan-Meier survival analysis revealed an accumulative survival at 30 days of 75%, at 120 days 70.84%, and at 180 days of 66.67% (standard error of 0.0962 with 95% CI). Embolization of bronchial arteries allowed the immediate control of massive hemoptysis in the majority of cases. Operators must be skilled and experienced.

Transcatheter arterial embolization in the treatment of massive hemoptysis.

Background: Massive hemoptysis is a major clinical and surgical problem related to high motality. Bronchial and nonbronchial systemic arteries are considered to be the main source of hemoptysis. Embolization of these arteries has become an accepted treatment in the management of massive hemoptysis. Herein we evaluate the effect of arterial embolization in immediate control of massive hemoptysis and investigate the clinical and angiographic characteristics and the course of patients with recurrent hemoptysis after initial successful embolization. Method: 21 patients (15 men & women, aged 21 to 74 years) underwent transcatheter arterial embolization for the treatment of life-threatening massive hemoptysis from Jan 1988 to July 1991. Seven patients had inactive residual pulmonary tuberculosis, 5 cases aspergilloma, 4 cases active pulmonary tuberculosis, 3 cases bronchiectasis and 2 case lung cancer. Arteriography was done by percutaneous catheterization via the femoral artery, and at the same time, arterial embolization was done with gelfoam particle. Result: Immediate control of massive hemoptysis was achieved in all 21 cases by arterial embolization. Hemoptysis recurred in nine of 21 patients. Four cases were aspergilloma, two inactive tuberculosis, two lung cancer, and one bronchiectasis. The initial angiographic findings revealed that nonbronchial systemic arterial supply, bronchial-pulmonary arterial shunt, and marked vascularity were more frequently, but statistically insignificant, in recurred patients. The following complications occured: fever, chest pain, cough, voiding difficulty, paralytic ileus, paraplegia, and splenic infarction. The course of the recurred patients was as follows: Three patients were died due to recurred massive hemoptysis. one was aspergilloma and two lung cancer. Surgical resection could be performed successfully in two patient with relatively good lung function, one aspergilloma and the other inactive tuberculosis. In 4 patients with poor lung function, repeated embolization or medical conservative treatment was continued. Conclusion: Arterial embolization as initial treatment of massive hemoptysis is most useful and relatively safe, although this is a palliative procedure and the potentiality for recurrence exists. Repeated embolization in inoperable patient with recurrent bleeding may improve the lengthening of life.

Control of Hemoptysis by Bronchial Artery Embolization

Control of massive hemoptysis by embolization of bronchial arteries was achieved in two patients with bronchopleural fistula. Both patients would have been prohibitive risks for thoracotomy. The indications, contraindications, and technique of the procedure are presented as well as a review of the literature.