Bronchial Artery Embolization Research Articles

Recurrent catamenial hemoptysis: diagnostic challenges and management strategies—a case report

Catamenial hemoptysis (CH) is a rare, known disease for which diagnosis is crucial and treatment is indefinite. In this case report, CH was identified 2 years ago while taking medical history of the patient. It has disclosed hemoptysis at night with breathlessness that was concurrent with her menses every month for the past 6 months. A series of radiological tests followed by a bronchoscopic examination during menses confirmed the diagnosis. A complex fluid-filled cystic lesion with few air foci in the right lower lobe superior segment with ground glass opacity was seen by a CT scan test. Subsequent bronchoscopy examination showed an active bleeding site at the right lower lobe superior segment. The bronchial wash tests were negative for microbial infections as well as for malignancies. Bronchial artery embolization (BAE) was done and it ceased the hemoptysis. However, it recurred after 2 years of the BAE procedure. The symptoms and amount of hemoptysis were milder; hence, repeated BAE was not required. Earlier, the patient refused hormonal therapy (HT) owing to its side effects, but this time, she accepted HT. After 2 months of HT, hemoptysis gradually ceased. If complications arise in the future, then surgical treatment along with HT (combination therapy) would be the course of treatment. The diagnosis of CH is challenging, and treatment procedures vary from patient to patient; hence, they are customised. Hormones regulate the CH recurrence even though the symptoms have ceased after treatment. Therefore, regular follow-up and close vigilance are crucial requirements.

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.

CLINICAL PROFILE OF PATIENTS WITH HEMOPTYSIS AT A TERTIARY CARE CENTRE IN CENTRAL INDIA: A RETROSPECTIVE STUDY OF 47 CASES

Background: Hemoptysis, the expectoration of blood from the respiratory tract, is a symptom with a wide spectrum of underlying causes, ranging from benign to life-threatening conditions. Understanding the clinical characteristics of these patients is vital for prompt diagnosis and effective management, particularly in tertiary care centers where complex cases are prevalent. Objective: To analyze the clinical presentations, diagnostic findings, and outcomes of patients presenting with hemoptysis at a tertiary care center. Materials and Methods: This retrospective observational study was conducted from January 2022 to December 2023 in the respiratory medicine department of a tertiary care center. A total of 47 patients aged over 18 years with confirmed hemoptysis were included. Data were collected from medical records, covering demographic details, clinical presentation, laboratory and radiological findings, bronchoscopy results, treatment methods, and outcomes. Descriptive statistics were employed to summarize the data. Results: The study cohort consisted of 47 patients with a mean age of 52 ± 14 years 60% were male. Acute hemoptysis was observed in 64% of cases. Hemoptysis severity was categorized as mild in 43%, moderate in 32%, and massive in 25% of patients. Common associated symptoms included cough (85%), fever (60%), weight loss (32%), chest pain (26%), and dyspnea (53%). Smoking history was present in 60% of patients. The predominant underlying conditions were COPD (30%), bronchiectasis (21%), tuberculosis (15%), lung cancer (11%), cardiovascular diseases (11%), and other conditions (13%). Abnormalities were detected in 74% of chest X-rays and 89% of CT scans, which included findings such as consolidation, cavitation, masses, and bronchiectasis. Bronchoscopy was performed in 51% of patients, with a diagnostic yield of 64%, revealing endobronchial lesions, bleeding sites, and inflammation. Management and Outcomes: Medical management included antibiotics (43%), bronchodilators (32%), steroids (19%), antitubercular therapy (15%), and anticoagulant reversal (6%). Interventional procedures, such as bronchial artery embolization, were performed in 11% of patients, and surgical resection was referred for 4% of patients. Hemoptysis resolution was achieved in 81% of cases, with a recurrence rate of 11% and a mortality rate of 6%. Discussion: COPD and bronchiectasis were the leading causes of hemoptysis, highlighting the prevalence of chronic respiratory diseases in the studied population. The significant diagnostic yield of CT chest and bronchoscopy underscores their importance in evaluating hemoptysis. Effective medical management was achieved in most cases, while interventional procedures were critical for controlling massive hemoptysis. The study identifies challenges in managing massive and recurrent hemoptysis and suggests the need for standardized management protocols. Conclusion: Hemoptysis in a tertiary care setting is frequently associated with chronic respiratory diseases such as COPD and bronchiectasis. Comprehensive diagnostic approaches, particularly CT chest and bronchoscopy, are crucial for effective management. Early identification and treatment of the underlying causes are essential for improving patient outcomes. The findings underscore the need for developing clinical guidelines and conducting further research on innovative diagnostic and therapeutic strategies.

CLINICAL PROFILE OF PATIENTS WITH HEMOPTYSIS AT A TERTIARY CARE CENTRE IN CENTRAL INDIA: A RETROSPECTIVE STUDY OF 47 CASES

Background: Hemoptysis, the expectoration of blood from the respiratory tract, is a symptom with a wide spectrum of underlying causes, ranging from benign to life-threatening conditions. Understanding the clinical characteristics of these patients is vital for prompt diagnosis and effective management, particularly in tertiary care centers where complex cases are prevalent. Objective: To analyze the clinical presentations, diagnostic findings, and outcomes of patients presenting with hemoptysis at a tertiary care center. Materials and Methods: This retrospective observational study was conducted from January 2022 to December 2023 in the respiratory medicine department of a tertiary care center. A total of 47 patients aged over 18 years with confirmed hemoptysis were included. Data were collected from medical records, covering demographic details, clinical presentation, laboratory and radiological findings, bronchoscopy results, treatment methods, and outcomes. Descriptive statistics were employed to summarize the data. Results: The study cohort consisted of 47 patients with a mean age of 52 ± 14 years 60% were male. Acute hemoptysis was observed in 64% of cases. Hemoptysis severity was categorized as mild in 43%, moderate in 32%, and massive in 25% of patients. Common associated symptoms included cough (85%), fever (60%), weight loss (32%), chest pain (26%), and dyspnea (53%). Smoking history was present in 60% of patients. The predominant underlying conditions were COPD (30%), bronchiectasis (21%), tuberculosis (15%), lung cancer (11%), cardiovascular diseases (11%), and other conditions (13%). Abnormalities were detected in 74% of chest X-rays and 89% of CT scans, which included findings such as consolidation, cavitation, masses, and bronchiectasis. Bronchoscopy was performed in 51% of patients, with a diagnostic yield of 64%, revealing endobronchial lesions, bleeding sites, and inflammation. Management and Outcomes: Medical management included antibiotics (43%), bronchodilators (32%), steroids (19%), antitubercular therapy (15%), and anticoagulant reversal (6%). Interventional procedures, such as bronchial artery embolization, were performed in 11% of patients, and surgical resection was referred for 4% of patients. Hemoptysis resolution was achieved in 81% of cases, with a recurrence rate of 11% and a mortality rate of 6%. Discussion: COPD and bronchiectasis were the leading causes of hemoptysis, highlighting the prevalence of chronic respiratory diseases in the studied population. The significant diagnostic yield of CT chest and bronchoscopy underscores their importance in evaluating hemoptysis. Effective medical management was achieved in most cases, while interventional procedures were critical for controlling massive hemoptysis. The study identifies challenges in managing massive and recurrent hemoptysis and suggests the need for standardized management protocols. Conclusion: Hemoptysis in a tertiary care setting is frequently associated with chronic respiratory diseases such as COPD and bronchiectasis. Comprehensive diagnostic approaches, particularly CT chest and bronchoscopy, are crucial for effective management. Early identification and treatment of the underlying causes are essential for improving patient outcomes. The findings underscore the need for developing clinical guidelines and conducting further research on innovative diagnostic and therapeutic strategies.

Abscopal effect after bronchial artery embolization for cancer-related hemoptysis

AbstractThe abscopal effect, a rare phenomenon in cancer treatment, involves tumor regression in a distant location from the targeted therapy. This case focuses on a 74-year-old woman with metastatic papillary thyroid cancer. Despite prior treatments, she experienced pulmonary nodule progression and hemoptysis. Bland particle embolization was performed on the right bronchial artery branches supplying lung metastases, leading to significant reductions in size, number, and metabolic activity of the right-sided nodules and decreased metabolic activity of the untreated left-sided nodules, without additional cancer-related treatments. The abscopal effect has been observed with various interventional oncologic procedures, indicating a potential role in stimulating the immune response and altering the tumor microenvironment. Further investigation is needed to understand bland embolization's immunomodulatory effects and implications for triggering the abscopal effect.

Bronchial artery embolization using small particles is safe and effective: a single center 12-year experience

Abstract Background Bronchial artery embolization (BAE) using particles is an established treatment for hemoptysis. The use of polyvinyl alcohol (PVA) with a particle size of 300 µm or larger is thought to reduce the risk of non-target embolization but may result in more proximal vessel occlusion than is ideal, resulting in a high rate of early recurrent hemorrhage. Objective This study evaluates the safety and efficacy of BAE using PVA particles with a size of less than 300 µm. Methods All patients who underwent BAE between 2010 and 2022 at a tertiary center were included. Demographic data, etiology and volume of hemoptysis, technical and clinical success, procedure-related complications, and follow-up information were collected from patients’ electronic records. 150–250 µm PVA particles were used to commence embolization in all patients with the subsequent use of larger-sized particles in some individuals. The Kaplan–Meier method was used to estimate recurrence and survival rates. Results One hundred forty-four patients underwent 189 embolization procedures between 2010 and 2022 and were followed up for a median of 35 months [IQR 19–89]. 150 µm to 250 µm PVA particles were used as the sole embolic agent in 137 cases. Hemoptysis recurred within 30 days in 7%. The median time to repeat intervention was 144 days [IQR 42–441]. Seventeen out of 144 patients had a pulmonary artery branch pseudoaneurysm. The rate of major complications was 1% with no instances of stroke or spinal artery ischemia. Thirty-day mortality was 2% (4/189). Conclusion BAE using 150–250 µm PVA particles is safe and effective with few complications and low rates of early hemoptysis recurrence. Clinical relevance statement BAE using small particles is likely to improve outcomes, particularly the rate of early recurrence, in patients with hemoptysis, without an increase in procedural complications. Key Points BAE is a safe and effective treatment for patients with hemoptysis. Using small PVA particles in BAE has few complications and low rates of early recurrence. Pulmonary artery pseudoaneurysms should be actively sought in those with hemoptysis undergoing BAE.

Efficacy and safety of CalliSpheres drug-eluting beads for bronchial arterial chemoembolization combined with intravenous chemotherapy for extensive-stage small cell lung cancer.

e20137 Background: We aim to explore the efficacy and tolerability of Drug-Eluting Bead Bronchial Arterial Chemotherapy Embolization (DEB-BACE) combined with intravenous chemotherapy in the treatment of patients with initially diagnosed extensive-stage small cell lung cancer (SCLC). Methods: We collected data from 24 patients with extensive-stage small cell lung cancer who received DEB-BACE combined with intravenous chemotherapy (DEB-BACE-V) and initially diagnosed at our hospital between 2013 and 2022. Among them, nine patients received BACE combined with intravenous chemotherapy from the first-line (first-line DEB-BACE-V), ten patients from the third-line (third -line DEB-BACE-V), and five patients from the second-line (second -line DEB-BACE-V). Then, the treatment response (objective response rate and rate of cancer regression) and tumor marker levels were evaluated at the first month and third month after treatment. The quality of life was assessed using the EORTC QLQ-C30 scale. Overall survival (OS) was also evaluated. First, compare the first-line DEB-BACE-V group with the second-line DEB-BACE-V group. Then, compare the first-line DEB-BACE-V group with third-line DEB-BACE-V group. Lastly, compare the second-line DEB-BACE-V group with the third-line DEB-BACE-V group. Results: In initially diagnosed extensive-stage SCLC patients treated with DEB-BACE combined with intravenous chemotherapy, first and third month post treatment, the objective response rates were 58.33% and 79.17%, respectively; and the rates of cancer regression were 75% and 91.67%, respectively. In addition, the neuron-specific enolase (NSE) and progastrin-releasing peptide levels were reduced at the third and sixth month. Quality of life assessed by EORTC QLQ-C30 scale, which included subscales of general health status, functional domains, symptom domains, and single domains except for financial difficulty, was markedly improved in first and third month of post treatment. Adverse reactions were mild and manageable, the most common being chest pain and low fever. Median values of OS in first-line DEB-BACE-V, second -line DEB-BACE-V and third -line DEB-BACE-V were 15.7 (95% CI: 9.1595-20.759) months, 29.63 (95% CI: 20.5684-36.268) months 16.92 (95% CI: 10.4044-21.871) months, and respectively. Conclusions: Due to its favorable therapeutic response, quality of life, survival benefits, and safety profile, DEB-BACE combined with intravenous chemotherapy may become a treatment option for patients with extensive-stage SCLC, particularly as second-line therapy.

Rare case of massive middle cerebral artery infarct after bronchial artery embolisation

Bronchial artery embolization (BAE) is a procedure that aims to control bleeding from bronchial arteries in massive and chronic haemoptysis. It is considered to be a life-saving measure in severe life-threating haemoptysis. Although it is minimally invasive and has a high success rate, it still carries a list of complications. These include post-embolisation syndrome, chest pain, back pain, dysphagia, vascular injury at the site of the embolisation leading to dissection, perforation, pseudoaneurysm and, very rarely, embolic infarction to non-target vessels. Stroke is one of the rare complications post BAE, and it can be severe and fatal. Few cases of stroke post BAE have been reported in the literature, and they were mainly due to posterior cerebral circulation infarction. Here, we report a case of a stroke post BAE due to massive middle cerebral artery (MCA) infarction and to our knowledge it seems to be the first reported case of MCA infarction post BAE. The discussion will cover the possible mechanisms of embolic passage, the outcome of the case including rehabilitation perspectives and the learning points. These will also highlight the importance of early recognition, which can save patients from a disabling stroke in the future.

Bronchial arterial embolization for an unruptured bronchial artery aneurysm in patient with hemoptysis.

Bronchial arterial embolization for an unruptured bronchial artery aneurysm in patient with hemoptysis.

Safety and efficacy of airway stent placement following bronchial artery embolization: A retrospective study at a single institute

BackgroundAirway stenting is an established procedure for treating oncological emergencies in patients with airway disorders. In patients with airway hemorrhage, respiratory conditions may worsen during stenting. Bronchial artery embolization (BAE) is useful to prevent bleeding from the bronchus. We aimed to evaluate the efficacy and safety of airway stenting after BAE in patients with malignant airway disorders. MethodsThe medical records of all patients who underwent airway stenting following BAE at the National Hospital Organization Okayama Medical Center between 2016 and 2023 were retrospectively reviewed. ResultsThirteen procedures (11 silicone Y stents, one hybrid stent, and one self-expandable metallic stent) were performed. The median duration from BAE to airway stenting was one day (range: 1–5 days). Nine patients experienced tumor shrinkage, and none experienced severe bleeding after BAE during the stent procedure. No other major complications were associated with the stent placement. The median survival time after stenting was 169 days (range; 24–1086). No serious complications caused by BAE, such as spinal cord infarction, were observed. ConclusionsAirway stent placement was safely performed after BAE without severe bleeding or acute respiratory failure. BAE, followed by airway stenting, is useful.

Destroyed lung contributes to the recurrence of hemoptysis after bronchial artery embolization in patients with post-tuberculosis bronchiectasis

BackgroundBronchiectasis has high rates of hemoptysis and recurrent hemoptysis, which is inconsistent among various etiologies. Idiopathic bronchiectasis and post-tuberculous bronchiectasis are two important etiologies in China, but the differences in clinical features and risk factors of recurrent hemoptysis have not been elucidated. MethodsPatients hospitalized for idiopathic bronchiectasis or post-tuberculosis bronchiectasis were included. Patients were followed up for at least 24 months post-BAE. Demographic characteristics and clinical data were collected and analyzed between idiopathic bronchiectasis and post-tuberculosis bronchiectasis. Based on the outcomes of recurrent severe hemoptysis in patients with post-tuberculosis bronchiectasis, Cox regression models were used to identify risk factors for recurrence. ResultsAmong 417 patients including 352 idiopathic bronchiectasis and 65 post-tuberculous bronchiectasis, 209 (50.1%) were females. Compared with the idiopathic group, the proportion of patients with female (54.5% vs. 26.2%, p < 0.001), with sputum (79.5% vs. 36.9%, p < 0.001), isolation of Pseudomonas aeruginosa (28.7% vs. 7.7%, p < 0.001), and the number of bronchiectatic lobes≥ 3(98.3% vs 50.8%, p < 0.001) were lower, and the proportion of destroyed lung (4.5% vs. 26.6%, p < 0.001) and recurrence of severe hemoptysis (22.4% vs. 41.5%, p = 0.001) were higher in the post-tuberculous group. Among patients with post-tuberculosis bronchiectasis, destroyed lung [HR: 3.2(1.1,9.1), p = 0.026] and abnormal esophageal proper artery [HR: 2.8(1.1,7.0), p = 0.032] were two independent risk factors for the recurrence of hemoptysis. ConclusionsThe recurrence rate of severe hemoptysis in patients with post-tuberculous bronchiectasis receiving BAE is high, and the proper esophageal artery should be actively evaluated and standardized treatment should be given.

Embosphere microspheres size for bronchial artery embolization in patients with hemoptysis caused by bronchiectasis: a retrospective comparative analysis of 500–750 versus 700–900 μm microspheres

BackgroundBronchial arterial embolization (BAE) has been accepted as an effective treatment for bronchiectasis-related hemoptysis. However, rare clinical trials compare different sizes of specific embolic agents. This study aims to evaluate whether different Embosphere microsphere sizes change the outcome of BAE.MethodsA retrospective review was conducted on consecutive patients with bronchiectatic hemoptysis who were scheduled to undergo BAE treatment during a period from January 2018 to December 2022. The patients received BAE using microspheres of different sizes: group A patients were treated with 500–750 μm microspheres, and group B patients were treated with 700–900 μm microspheres. The cost of embolic microspheres (Chinese Yuan, CNY), duration of hospitalization, complications, and hemoptysis-free survival were compared between patients in group A and those in group B. A Cox proportional hazards regression model was used to identify predictors of recurrent hemoptysis.ResultsMedian follow-up was 30.2 months (range, 20.3–56.5 months). The final analysis included a total of 112 patients (49–77 years of age; 45 men). The patients were divided into two groups: group A (N = 68), which received 500–750 μm Embosphere microspheres, and group B (N = 44), which received 700–900 μm Embosphere microspheres. Except for the cost of embolic microspheres(group A,5314.8 + 1301.5 CNY; group B, 3644.5 + 1192.3 CNY; p = 0.042), there were no statistically significant differences in duration of hospitalization (group A,7.2 + 1.4 days; group B, 8 + 2.4days; p = 0.550), hemoptysis-free survival (group A, 1-year, 2-year, 3-year, 85.9%, 75.8%, 62.9%; group B, 1-year, 2-year, 3-year, 88.4%, 81.2%,59.4%;P = 0.060), and complications(group A,26.5%; group B, 38.6%; p = 0.175) between the two groups. No major complications were observed. The multivariate analysis results revealed that the presence of cystic bronchiectasis (OR 1.61, 95% CI 1.12–2.83; P = 0.001) and systemic arterial-pulmonary shunts (SPSs) (OR 1.52, 95% CI 1.10–2.72; P = 0.028) were independent risk factors for recurrent bleeding.ConclusionsFor the treatment of BAE in patients with bronchiectasis-related hemoptysis, 500–750 μm diameter Embosphere microspheres have a similar efficacy and safety profile compared to 700–900 μm diameter Embosphere microspheres, especially for those without SPSs or cystic bronchiectasis. Furthermore, the utilization of large-sized (700–900 μm) Embosphere microspheres is associated with the reduced cost of an embolic agent.

A pulmonary artery was embolized in a patient with an occluded pulmonary vein to manage massive hemoptysis

BackgroundStenosis and obliteration of the pulmonary vein can be developed by multiple diseases and might cause hemoptysis. Traditional therapy including surgical procedure and conservative treatments might be inappropriate choices to manage massive hemoptysis.Case presentationA 64-year-old man, diagnosed with advanced stage IVA lung squamous cell carcinoma, presented with dyspnea and recurrent, massive hemoptysis. An initial contrast-enhanced computed tomography revealed a giant tumor in the left lung hilus and occlusion of the left superior pulmonary vein. Despite immediate selective bronchial artery embolization and simultaneous embolization of an anomalous branch of the internal thoracic artery, the massive hemoptysis continued. Subsequently, embolization of the left superior pulmonary artery was performed, achieving functional pulmonary lobectomy, which successfully treated the hemoptysis without relapse during a six-month follow-up. The patient continues to undergo cancer therapy and remains stable.ConclusionsThis case successfully managed massive hemoptysis associated with lung cancer invasion into the pulmonary vein through functional pulmonary lobectomy via embolization of the corresponding pulmonary artery.

A rare and late complication of lung cancer: bronchial rupture

Abstract Background Tracheobronchial injuries generally occur due to iatrogenic or traumatic causes. Although bronchial rupture due to teratoma and germ cell tumors has been reported in the literature, no cases related to lung cancer have been determined. Our case is presented because of the refusal to be examined for the mass in the lung and the detection of bronchial rupture afterward when he presented with massive hemoptysis. Case presentation A 65-year-old male patient was admitted to the emergency department with the complaint of massive hemoptysis. Six months ago, bronchoscopy was recommended due to the 8 × 7 cm cavitary lesion obliterating the bronchus in the anterior upper lobe of the right lung on chest computed tomography, but the patient refused. The sputum sample, requested 3 times, was negative for acid-resistant bacteria, and no growth was detected in the mycobacterial culture. In the new pulmonary CT angiography, a progressive cavitary lesion invading the right main bronchus, carina, and vena cava superior was observed. Following tranexamic acid treatment and bronchial artery embolization, hemoptysis significantly decreased in the follow-up. In the flexible bronchoscopy performed for diagnostic purposes, the carina was pushed to the left and invaded, and there was damage to the right main bronchus. A biopsy was not performed due to the risk of bleeding, and lavage was performed. Lavage was negative for ARB, there was no growth in the mycobacteria culture, and cytology did not reveal malignant cells. The patient, diagnosed with right main bronchial rupture, was considered inoperable and died 1 month later due to respiratory failure. Conclusions Examinations should be initiated as soon as malignancy is suspected. When diagnosis and treatment are delayed, complications that would be challenging to intervene may develop.

Evaluation of The Relationship Between the Selected Particle Size and Procedure Success and Complications in Bronchial Artery Embolisation

Objective: Hemoptysis refers to the discharge of blood, which originates from the lungs or bronchial system through the mouth. This study aimed to examine the importance of the particle size used in patients undergoing bronchial artery embolisation (BAE) regarding procedure success and complications.&#x0D; Materials and Methods: Data from patients who underwent BAE using polyvinyl alcohol (PVA) particles were collected retrospectively. Hemoptysis etiology and localisation, lesion type, the size of the embolising agent used, and postoperative complications were recorded. Thirty-day follow-up results were evaluated.&#x0D; Results: Fifty-six patients were included in the study. The size of the PVA particles used was 300-500 microns in 30 patients (53.6%) and 500-700 microns in 26 patients (46.4%). Bleeding completely stopped in 92.9% of the cases within 30 days after the procedure. Procedure success or complications did not significantly differ between the patient groups in which 300-500 micron and 500-700 micron particles were used during BAE.&#x0D; Conclusion: BAE is a safe, effective, and minimally invasive method that can be performed repeatedly to treat hemoptysis. This study showed that regardless of size, PVA particles were effective and safe agents that could be used during this procedure.

Establishment of Diagnostic Reference Levels in Portuguese Interventional Radiology departments

PurposeTo establish Portuguese Diagnostic Reference Levels (DRLs), for six body fluoroscopy guided interventional procedures (FGIP). MethodA retrospective study was conducted in five interventional departments most representative of Interventional Radiology (IR) practice. Dose values, in terms of air kerma area product (PKA in Gy.cm2), air kerma at the patient entrance reference point (Ka,r in mGy), and exposure parameters (fluoroscopy time (FT) and number of cine runs) were collected. Examinations were selected per procedure (at least 20), according to the antero-posterior and lateral diameter mean value (±5 cm), measured on previous Computed Tomography (CT) examinations. ResultsData of 489 body FGIP show a large variation on dose values per procedure and per department. National DRLs in terms of PKA were 20.2 Gy.cm2 for Percutaneous transhepatic biliary drainage (PTBD), 98.2 Gy.cm2 for Bronchial artery embolisation (BAE), 247.7 Gy.cm2 for Transarterial chemoembolisation (TACE), 331.6 Gy.cm2 for Inferior epigastric arteries embolisation (IEAE), 312.0 Gy.cm2 for Transjugular intrahepatic portosystemic shunt (TIPS) and 19.3 Gy.cm2 for Endovascular treatment of femoral popliteal arteries (ETFPA). ConclusionsThis is the first study reporting Interventional Radiology DRLs in Portugal and we propose preliminary national estimates for the six more common body FGIP. The results of this study will be presented and discussed with all Portuguese IR departments, to promote procedures optimisation.

Low bleeding rates following transbronchial lung cryobiopsy in unclassifiable interstitial lung disease.

Bronchoscopic transbronchial lung cryobiopsy (TBLC) is a guideline-endorsed alternative to surgical lung biopsy for tissue diagnosis in unclassifiable interstitial lung disease (ILD). The reported incidence of post-procedural bleeding has varied widely. We aimed to characterize the incidence, severity and risk factors for clinically significant bleeding following TBLC using an expert-consensus airway bleeding scale, in addition to other complications and diagnostic yield. A retrospective cohort study of consecutive adult outpatients with unclassifiable ILD who underwent TBLC following multidisciplinary discussion at a single centre in the UK between July 2016 and December 2021. TBLC was performed under general anaesthesia with fluoroscopic guidance and a prophylactic endobronchial balloon. One hundred twenty-six patients underwent TBLC (68.3% male; mean age 62.7 years; FVC 86.2%; DLCO 54.5%). Significant bleeding requiring balloon blocker reinflation for >20 min, admission to ICU, packed red blood cell transfusion, bronchial artery embolization, resuscitation or procedural abandonment, occurred in 10 cases (7.9%). Significant bleeding was associated with traction bronchiectasis on HRCT (OR 7.1, CI 1.1-59.1, p = 0.042), a TBLC histological pattern of UIP (OR 4.0, CI 1.1-14, p = 0.046) and the presence of medium-large vessels on histology (OR 37.3, CI 6.5-212, p < 0.001). BMI ≥30 (p = 0.017) and traction bronchiectasis on HRCT (p = 0.025) were significant multivariate predictors of longer total bleeding time (p = 0.017). Pneumothorax occurred in nine cases (7.1%) and the 30-day mortality was 0%. Diagnostic yield was 80.6%. TBLC has an acceptable safety profile in experienced hands. Radiological traction bronchiectasis and obesity increase the risk of significant bleeding following TBLC.

Pulmonary ligament rupture due to a bronchial artery aneurysm-induced hematoma: a case report

BackgroundBronchial artery aneurysm (BAA) is a rare vascular anomaly with the potential for serious complications, such as rupture leading to hemothorax or hemoptysis. Although bronchial artery embolization (BAE) is recognized as an effective intervention for ruptured BAA, video-assisted thoracoscopic surgery (VATS) is a minimally invasive approach for the treatment of associated hemothorax.Case presentationA 73-year-old woman presented with a mediastinal hematoma from a ruptured BAA, causing bilateral hemothorax. Emergency angiography revealed a saccular BAA that was successfully embolized using a microcatheter and coil. Subsequent computed tomography revealed an expanding hemothorax managed by VATS, with 1400 mL of blood drained. During VATS, thoracoscopy revealed pulmonary ligament rupture, which was attributed to increased intramediastinal pressure. The patient was discharged eight days postoperatively with no complications. This case highlights the use of BAE and VATS in the management of mediastinal BAA rupture and massive hemothorax.ConclusionsBAE proved to be an effective strategy for the management of ruptured mediastinal BAAs. VATS is a valuable standby procedure for hematoma removal, but the indication should be carefully determined because of the risk of BAA re-rupture.

Neurovascular complications post bronchial artery embolisation in patients with cystic fibrosis. A 7-year single centre retrospective review

Bronchial artery embolisation (BAE) is a treatment used to manage haemoptysis. We performed a 7-year review of BAE procedures for haemoptysis at our CF centre aiming to evaluate the incidence and outcomes of patients with neurovascular complications post-BAE. Our review suggests that whilst BAE is an effective method for controlling life-threatening haemoptysis, patients are at risk of developing neurovascular complications with long term residual symptoms, and therefore careful consideration should be given in offering BAE, especially to otherwise well patients with chronic small volume haemoptysis and managing teams should have a low threshold to image symptomatic patients.

Bronchial artery embolization in patients with life-threatening massive hemoptysis: comparison of the efficacy and safety of particulate embolizing agents and n-2-butyl-cyanoacrylate.

Comparing the efficacy and safety of particulate [microspheres/polyvinyl alcohol (PVA)] and non-particulate [n-butyl-2-cyanoacrylate (NBCA)] agents used as the embolic agents for bronchial artery embolization (BAE) intervention in patients experiencing massive hemoptysis. A total of 58 individuals (47 male, 11 female, standard deviation = 53.9 ± 14.8, age range = 18-84) were recruited for a retrospective study in a single unit. Thirty (51.7%) of the patients underwent BAE intervention with NBCA, and 28 (48.3%) underwent the same procedure with a particulate embolizing agent (microspheres/PVA). The demographic distribution of the patients, the etiological factors, the technical and clinical success rates, and complications were documented, with the two groups subsequently compared. The technical and clinical success rates following the procedure were 100% for both groups. The average follow-up duration was 34 months in the NBCA group and 33.5 months in the particulate embolizing agent group. In comparison, the rate of recurrent hemoptysis was 3.3% in the former and 17.9% in the latter, with the presence of recurrent hemoptysis not statistically different between the two groups (p = 0.097). Major complications and procedural death did not occur in either of the samples. The use of NBCA in BAE presents a safe and effective method. The combination of NBCA and particulate embolizing agents (PVA/microspheres) achieved equal technical and clinical success and significantly increased the hemoptysis-free survival rates in terms of life-threatening hemoptysis. (1) In managing massive hemoptysis, using NBCA is a safe and effective method similar to using particulate embolizing agents. (2) Although not statistically significant, recurrent hemoptysis is observed less frequently in the NBCA group. (3) Technique and clinical success were relatively high and similar in the groups where NBCA and particulate embolizing agents were used.