Treatment Of Massive Hemoptysis Research Articles

Which Is the Best Way to Treat Massive Hemoptysis? A Systematic Review and Meta-Analysis of Observational Studies.

Hemoptysis is one of the most common symptoms of respiratory system diseases. Common causes include bronchiectasis, tumors, tuberculosis, aspergilloma, and cystic fibrosis. The severity of hemoptysis varies from mild to moderate to massive hemoptysis and can easily lead to hemodynamic instability and death from suffocation or shock. Nevertheless, the most threatening hemoptysis that is presented to the emergency department and requires hospitalization is the massive one. In these cases, today, the most common way to manage hemoptysis is bronchial artery embolization (BAE). A systematic literature search was conducted in PubMed and Scopus from January 2017 (with the aim of selecting the newest possible reports in the literature) until May 2023 for studies reporting massive hemoptysis. All studies that included technical and clinical success rates of hemoptysis management, as well as rebleeding and mortality rates, were included. A proportional meta-analysis was conducted using a random-effects model. Of the 30 studies included in this systematic review, 26 used bronchial artery embolization as a means of treating hemoptysis, with very high levels of both technical and clinical success (greater than 73.7% and 84.2%, respectively). However, in cases where it was not possible to use bronchial artery embolization, alternative methods were used, such as dual-vessel intervention (80% technical success rate and 66.7% clinical success rate), customized endobronchial silicone blockers (92.3% technical success rate and 92.3% clinical success rate), antifibrinolytic agents (50% clinical success rate), and percutaneous transthoracic embolization (93.1% technical success rate and 88.9% clinical success rate), which all had high success rates apart from antifibrinolytic agents. Of the 2467 patients included in these studies, 341 experienced rebleeding during the follow-up period, while 354 other complications occurred, including chest discomfort, fever, dysphagia, and paresis. A total of 89 patients died after an episode of massive hemoptysis or during the follow-up period. The results of the meta-analysis showed a pooled technical success of bronchial artery embolization equal to 97.22% and a pooled clinical success equal to 92.46%. The pooled recurrence was calculated to be 21.46%, while the mortality was 3.5%. These results confirm the ability of bronchial artery embolization in the treatment of massive hemoptysis but also emphasize the high rate of recurrence following the intervention, as well as the risk of death. In conclusion, massive hemoptysis can be treated with great clinical and technical success using bronchial artery embolization, reducing mortality. Mortality has now been reduced to a small percentage of cases.

Treatment of massive hemoptysis after thoracic aortic aneurysm repair

BackgroundMassive hemoptysis after thoracic aortic aneurysm (TAA) repair is a rare but potentially lethal condition. Endovascular management is a challenging treatment option due to the complexity of culprit vessel access.Case presentationAn 81-year-old woman was referred to our hospital with massive hemoptysis. She had a history of graft replacement and thoracic endovascular aortic repair (TEVAR) for dissecting TAA. Computed tomography (CT) showed massive atelectasis with hematoma in the left lower lung lobe adjacent to the descending aortic aneurysm treated with TEVAR. Contrast-enhanced CT revealed a pseudoaneurysm and proliferation of abnormal vessels at the peripheral side of the left pulmonary ligament artery (PLA) in the atelectasis. The PLA continued to the right subscapular artery via a complex collateral pathway. Diagnostic angiography of the right subcapsular artery revealed a pseudoaneurysm and abnormal vessels at the peripheral side of the left PLA with a systemic-pulmonary artery shunt. Transcatheter arterial embolization (TAE) for the left PLA via the collateral pathway with N-butyl cyanoacrylate achieved complete embolization. The patient’s hemoptysis was controlled and she was discharged.ConclusionsHere we presented a case of massive hemoptysis due to PLA disruption that occurred after TAA repair. TAE via a complex collateral pathway is a feasible and effective treatment for hemoptysis, even in patients who have undergone surgical or endovascular TAA repair.

Effect of PVA artery embolization through coaxial microcatheter in the treatment of massive hemoptysis

目的 探讨同轴微导管技术聚乙烯醇(PVA)颗粒栓塞支气管动脉治疗大咯血的有效性、安全性。 方法 选取浙江普陀医院2015年8月至2019年10月收治的咯血患者42例为研究对象，对患者行支气管动脉及其它责任血管造影，并根据术中造影结果选用PVA颗粒行栓塞治疗，术后随访1～12个月，对栓塞治疗效果、安全性进行评价。 结果 42例患者栓塞后24 h内咯血症状消失；5例患者在术后1～12个月行2～3次介入术后症状消失；1例患者行3次介入术后仍有间断性咯血。患者术中均未出现异位栓塞情况。 结论 同轴微导管技术PVA颗粒栓塞供血动脉能有效制止咯血，明显减少栓塞后血管再通，栓塞过程中及栓塞后无明显严重并发症。

The Novel Use of the Amplatzer Occlusion Device to Aid in the Treatment of Massive Hemoptysis

Massive hemoptysis is generally used to describe the expectoration of a large amount of blood and/or a rapid rate of bleeding, although the precise thresholds that constitute massive hemoptysis are controversial. Unfortunately, few options exist for the treatment of active bleeding from benign airway lesions. This case report highlights a challenging clinical situation where placement of an Amplatzer occlusion device over a proximal bleeding vessel resulted in cessation of hemorrhage until vascular embolization could be performed. The use of the Amplatzer occlusion device within the airways can be an effective intervention to aid in the treatment of massive hemoptysis.

P4708Ttransradial approach for bronchial artery embolization

Abstract Background Bronchial artery embolization (BAE) is considered the most effective nonsurgical emergent treatment for massive hemoptysis, which holds 50%-100% mortality rate if treated conservatively. The transradial approach (TRA) is becoming more popular than the transfemoral approach (TFA) in percutaneous coronary intervention. Purpose To compare systematically transradial approach and the transfemoral approach in bronchial artery embolization. Methods We had analyzed the clinical, angiographic and technical results of BAE performed between 2014 and 2017. In the present study 58 patients with massive hemoptysis that underwent BAE via the TRA (n=29) or the TFA (n=29) were analyzed. Clinical factors and outcomes in these two groups were compared. Results The prevalence of artery vasospasm significantly higher (P<0.05) and the puncture time was significantly longer (P<0.05) in patients who underwent BAE via the TRA rather than via the TFA. However, the complication rate was significantly lower (P<0.05) and the time bedridden (P<0.05) and artery compression time (P<0.05) were significantly shorter via the TRA than via the TFA. Conclusion These results suggest that BAE via the TRA was associated with a lower complication rate, and shorter artery compression time and bedridden time than BAE via the TFA. Transradial bronchial artery embolization is technically feasible and safe procedure.

Morphological analysis of bronchial arteries and variants with computed tomography angiography, and its relevance in the treatment of massive hemoptysis

Massive hemoptysis is a life‐threatening clinical event. Its main etiology is secondary to rupture of the bronchial arteries and rarely from other systemic arteries or the pulmonary artery. The aim of our study was to determine the prevalence of anatomical variants of bronchial arteries using computed tomographic angiography in a population of northeastern Mexico.Materials and MethodsAn observational, transversal, descriptive, comparative, retrospective study was performed using 139 imaging studies of Mexican patients in which we evaluated the following parameters from the left and right bronchial arteries: artery origin, branching pattern, arterial ostium, vertebral level of origin, diameter, and mediastinal trajectory.ResultsThe anatomy of the bronchial arteries was similar in both genders, except distribution for vertebral origin level (p 0.006) and the diameter (p 0.013). Left and right arteries were similar, except for the mediastinal trajectory in reference to the esophagus (p <0.001) as well as the arterial diameter (p <0.001).ConclusionOur study is the first to assess comprehensively by computed angiotomography the anatomy of the bronchial arteries, common trunks and intercostobronquiales trunks in the same population. We are the first to report all branching patterns found and perform statistical analysis for all parameters according to gender and side.

AB032. Successful treatment of massive hemoptysis with endovascular stenting in patient with aortobronchial fistula and history of operated thoracic aortic dissection

AB032. Successful treatment of massive hemoptysis with endovascular stenting in patient with aortobronchial fistula and history of operated thoracic aortic dissection

大量喀血例に対する気管支動脈栓塞術 : 再施行時の気管支動脈造影所見および術前処置としての意義(気道出血)

大量喀血例に対する気管支動脈栓塞術 : 再施行時の気管支動脈造影所見および術前処置としての意義(気道出血)

The application of interventional nursing on selective bronchial artery embolization

Objective To study the interventional nursing on selective bronchial artery embolization. Methods In our hospital from 2011 January to 2013 September, 90 massive hemoptysis patients treated with selective bronchial artery embolization were randomly divided into observation and control groups, each group had 45 cases. The control group was given routine postoperative treatment, the observation group was given system nursing on the basis of the control group, the therapeutic effect and recurrence rate in two groups were compared and analyzed. Results The therapeutic effect rate of observation group(95. 56%) was significantly better than that of control patients (66. 67%, P<0. 05). The recurrence rate in observation group(2. 22%) was significantly lower than that of control group(17. 78%), P<0. 05. Conclusions Selective bronchial artery embolization in treatment of massive hemoptysis could be effective, interventional nursing can increase the effective rate and reduce the relapse rate, promote the rehabilitation of patients. Key words: Selective; Bronchial artery embolization; Interventional nursing

Pulmonary resection in the treatment of life-threatening hemoptysis.

Massive hemoptysis is a life threatening situation with high mortality rates. Surgery is effective, however generally an avoided treatment. We report our experience with patients undergoing lung resection for life-threatening hemoptysis. Records of all surgically treated patients for hemoptysis between June 2009 and June 2012 were reviewed and analyzed retrospectively. Anatomical resection was performed on 31 (15.3%) patients out of 203 patients referred to our intensive care unit for life-threatening hemoptysis. 25 (80.6%) were male and six (19.4%) were female; with mean age of 46.4 ± 13.7 (21-77). Pneumonectomy was performed in four (12.9%), lobectomy in 24 (77.4%), segmentectomy in two (6.5%) and bilobectomy in one case. Postoperative complications developed in eight (25.8%), and mortality was observed in two (6.5%) patients. Etiology was bronchiectasis in 13 (42.0%), tuberculosis in eight (25.8%), carcinoma in four (12.9%), aspergilloma in four (12.9%), hydatid cyst in one (3.2%) and lung abscess in one (3.2%) of the cases. Although lung resection in the treatment of massive hemoptysis is accompanied with high morbidity and mortality rates, surgery is the only permanent curative modality. Acceptable results can be achived in the company of a multidisciplinary approach, through avoidance of pneumonectomy and urgent surgery.

Emergency transcatheter arterial embolization for massive hemoptysis due to pulmonary tuberculosis and tuberculosis sequelae.

To explore the strategy and curative effect of emergency transcatheter arterial embolization (ETAE) in patients with massive hemoptysis due to pulmonary tuberculosis and tuberculosis sequelae. A total of 148 patients with massive hemoptysis due to pulmonary tuberculosis underwent emergency arteriography. After the bleeding artery was located, patients were given embolotherapy using gelfoam strips, coils, and polyvinyl alcohol particles. The arteriography manifestations and therapeutic outcomes in all patients were retrospectively analyzed. ETAE was performed successfully in 143 patients after location of the bleeding arteries. The bleeding arteries could not be located in another five patients, and embolotherapy, therefore, could not be performed. Among these five patients, three underwent surgical resection and two died of complications of tuberculosis/fungal ball coinfection. During a 2-year follow-up period, there were 15 cases of recurrent hemoptysis after initial embolotherapy. Among these, four cases were resolved by re-embolization, 11 patients still had massive hemoptysis after re-embolization who underwent surgical resection and resolved the hemoptysis eventually. Successful hemostasis was achieved by ETAE in 132 patients (89.19%; 132/148). No severe complications occurred after embolotherapy. ETAE is a safe and effective treatment for massive hemoptysis due to pulmonary tuberculosis. The key to successful treatment is thorough and complete embolization of the bleeding arteries. In the event of failure of embolotherapy, surgical resection should be used to resolve the bleeding.

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.

Bronchial Artery Embolization for Massive Hemoptysis: a Retrospective Study

Introduction: To assess the efficacy and safety of bronchial artery embolization in the treatment of massive hemoptysis. Materials and Methods: A retrospective study on 46 patients (26 males and 20 females) who were referred to the Razavi Hospital from April 2009 to May 2012 with massive hemoptysis and had bronchial artery embolization procedures. General characteristics of the patients including age, gender, etiology, and thorax computed tomograms, findings of bronchial angiographic, results of the embolization, complications related to bronchial artery embolization and clinical outcome during follow-up were reviewed. Results: The etiology included previous pulmonary tuberculosis in 20 cases, previous tuberculosis with bronchiectasis in 16 cases, bronchiectasis in 6 cases, and active pulmonary tuberculosis in one case. No identifiable causes could be detected in three patients. Moreover, massive hemoptysis was successfully and immediately controlled following the embolization procedure in all patients. One patient developed recurrent hemoptysis during one month following the procedure and was treated by re-embolization. No major procedure–related complication such as bronchial infarction was identified However none of the patientsexperienced neurological complications. Conclusion: Bronchial artery embolization is a safe and effective means of controlling massive hemoptysis and should be regarded as the first-line treatment for this condition.

Treatment of Massive Hemoptysis Occurred from Destroyed Lung: Prevention of Contralateral Aspiration Using Endobronchial Blocker Followed by Pneumonectomy

Untreated massive hemoptysis, especially in patients with tuberculous-destroyed lung, is a serious complication resulting in considerable morbidity and mortality. We report a case of a patient who had active tuberculosis and a destroyed left lung with massive bleeding. He was transferred to our clinic with intubation of a right-sided Robertshaw double lumen tube and right upper lobe collapse likely due to tube malposition that was presented on chest X-ray. Because hemoptysis had persisted after bronchial arterial embolizaton, we replaced the double lumen tube with a conventional endotracheal tube and inserted an endobronchial blocker into the left main bronchus through an endotracheal tube guided by bronchoscopy to prevent aspiration of blood into the right lung. Left pneumonectomy was performed and hemotpysis was ceased. We suggest that the use of an endobronchial blocker followed by surgery may be a safe and effective modality of treatment in patients with persistent bleeding after bronchial arterial embolization.

Use of Fibrin Sealant Glue as a Treatment for Massive Hemoptysis

In patients presenting with massive hemoptysis, it is often challenging to control bleeding. Uncontrolled bleeding can lead to hemodynamic compromise, asphyxiation, and high mortality. We present a case of a patient who presented with massive hemoptysis, and the use of fibrin sealant glue through a bronchoscopic catheter, which was effective in controlling bleeding.

Long-term outcome of bronchial artery embolization in the treatment of massive hemoptysis

To study the long-term outcome, safety, and complications of bronchial artery embolization (BAE) in the treatment of patients with massive hemoptysis. A retrospective analysis of 232 cases of massive hemoptysis treated with BAE from February 2000 to February 2009 in our hospital was carried out. All cases were followed by repeated X-ray or CT examination, telephone calls, or questionnaires, with the longest period up to 9 years. There were 627 blood vessels which were totally embolized by 741 coils for the 232 cases. The hemoptysis was stopped instantly in 100% of the patients. 91.8% (213/232) of the cases were cured and 19 cases (19/232, 8.18%) were improved. The overall effective rate was 100% (232/232). No serious or delayed complications occurred. None of the patients died. Bronchial artery embolization is effective in cases with massive hemoptysis for its immediate effect and safety.

Transcatheter embolization of bronchial arteries in the treatment of haemoptysis

Background. Massive haemoptysis is a clinical state characterized by the expectoration of blood at a rate of 300-600 mL/24 h, thus causing life-threatening asphyxia. The aim of our study is to review use of transcatheter bronchial artery embolization (BAE) in the treatment of massive haemoptysis. Materials and methods. Series of 11 patients with the clinical picture of massive haemoptysis was referred to our hospital for digital subtraction angiography and BAE within a 33 months period. There were 8 male (aged 43-69, mean age 56) and 3 female patients (aged 63-65, mean age 64). Aortography of thoracic aorta was initially performed in all patients, followed by selective angiography of bronchial and intercostal arteries, and intercostobronchial tree as indicated. A selective arterial embolization was done in 9 patients (9 primary and 3 secondary embolizations). The embolization was performed under fluoroscopy control by manual injection of the mixture of contrast solution (1 ccm) and embolization material, Embosphere (BioSphere Medical Inc., MA, USA), particle size 350-500 μm. Results. Bronchiectasis was the most common cause of bleeding (45.4%), while hypervascularization and intensive parenchymal opacification were the most frequent angiographic indicators of bleeding (100%), followed by tortuous and hypertrophic arteries (72.7%). Primary BAE proved successful in 81.9% and secondary BAE performed within 24 months in 33.3% of patients, whereas the tertiary (operative) treatment was required in 22.2% of patients. In 44.4% of patients, BAE was associated with only mild discomforts, like pain and cough. Conclusions. BAE is a reliable and minimally invasive method in the management of massive haemoptysis. Therefore, it should be considered as the primary method of the treatment or as a procedure for the stabilization the patient before the surgery.

L’hémoptysie massive : prise en charge et traitement Quelle est la place de la chirurgie ?

To define the role of interventional radiology and surgery respectively, in the treatment of massive haemoptysis. GENERAL CONSIDERATIONS: For the management of massive haemoptysis in non-terminal pathologies an intensive care facility and a multi-disciplinary team are necessary. It is of paramount importance to identify rapidly the pulmonary or bronchial source of the bleeding. CT scanning and bronchoscopy are essential to localise the bleeding and determine its cause. Initial management. An attempt to control the initial bleeding to allow localisation of its origin and determine the treatment. Bronchial or systemic embolisation and surgery are the only effective medium and long-term treatments. Embolisation achieves excellent results in bleeding from bronchial or parietal systemic arteries prior to surgery and may be the only technique possible in the presence of major co-morbidity. Surgery is necessary in the case of failure, in certain specific conditions, and in the case pulmonary artery haemorrhage from a proximal lesion. Various surgical techniques are available depending on the type of lesion encountered and the facilities for post-operative care. Emergency surgery carries a high risk and deferred surgery gives better results. The management of massive haemoptysis should be multi-disciplinary. Intensive care, respiratory and radiological diagnosis, Surgical management and interventional radiology should be combined to improve the prognosis of this grave condition. Pulmonary arterial haemorrhage from a necrotic tumour constitutes a surgical emergency and should be operated on without delay.

Use of endoscopic fibrinogen–thrombin in the treatment of severe hemoptysis

Bronchial artery embolization (BAE) is the treatment of choice in the majority of patients with severe hemoptysis. However, this procedure may be unavailable and even fail or be counterindicated in 4–13% of cases. In these cases, the efficacy of fibrinogen–thrombin (FT) instilled endoscopically as treatment for massive hemoptysis was assessed. Between August 1993 and February 1996 a prospective clinical study was performed. FT instillation was indicated in all patients with severe hemoptysis (>150ml/12h) in whom BAE had failed, was counterindicated or not available. FT was instilled endoscopically. Patients were followed up until June 2001. Eleven of 101 patients (11%) with hemoptysis >150ml/12h in whom BAE was not possible or proved ineffective were included. The severe hemoptysis was controlled immediately in all cases. During the follow-up period (mean: 39.4 months), early relapse of the severe hemoptysis occurred in two patients (18%) and a long- time relapse in one. Mean procedure duration was 3min and no attributable complications were observed in any case. In conclusion, these results suggest that topical treatment with FT could be considered in the initial endoscopic evaluation of patients with severe hemoptysis while awaiting BAE or surgery, or as alternative treatment to arterial embolization when the latter is not available, has proved ineffective or is counterindicated.

Fibreoptic bronchoscopy based bronchial infusion therapy in treating haemoptysis

Massive Haemoptysis is a potentially life-threatening condition which often requires treatment in an emergency room environment. This problem becomes more alarming in patients when fibreoptic bronchoscopy (FOB) is used as a diagnostic tool. In this study 49 cases were included who either had constant blood mixed sputum (16 cases), or had one or more episodes of massive haemoptysis within 24 hours or during the FOB procedure (33 cases). Various non surgical therapies evolved in the past have been used by us to stop the bleeding in such cases using FOB. This study reports the results of fibreoptic bronchoscopy based procedures for lung extract (Hemoplastin) and botropase infusion therapy (BIT), as an alternative to thrombin and fibrinogen which are not commercially available in India. The method was very effective in 33 cases, effective in 11 cases and ineffective in 5 cases. We conclude that BIT using botropase and hemoplastin infusion therapy is safer and an effective alternative to Bronchial artery embolization BAE for the treatment of massive haemoptysis. We recommend their use as topicalhemostatic agents.