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Fan S, Cheng X, Wang X, Liu Y, He W, Chen H. Bronchial artery embolization versus conservative treatment for hemoptysis: a systematic review and meta-analysis. BMC Pulm Med 2024; 24:428. [PMID: 39215233 PMCID: PMC11365234 DOI: 10.1186/s12890-024-03244-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Bronchial artery embolization (BAE) is currently an important treatment for hemoptysis. However, there is no consensus in the efficacy and safety of BAE compared to conservative treatment for hemoptysis, which limits the widespread use of BAE in hemoptysis. The objective was to assess the clinical benefit of BAE versus conservative treatment in patients with hemoptysis. METHODS A systematic search was conducted on the PubMed, Embase, ScienceDirect, CochraneLibrary, and ClinicalTrials up to March 2023. Both randomized controlled trials (RCTs) and cohort studies reporting rates of recurrent hemoptysis, clinical success, mortality, and complication by BAE and conservative treatment alone for hemoptysis were included. Data were pooled and compared by the use of odds ratio (OR) and 95% confidence interval (CI). RESULTS Twelve studies (three RCTs, nine cohorts) involving 1231 patients met the eligibility criteria. Patients treated with BAE had lower recurrence rates of hemoptysis (26.5% vs. 34.6%; OR 0.37, 95% CI 0.14-0.98), higher clinical success rates (92.2% vs. 80.9%; OR 2.77, 95% CI 1.66-4.61), and lower hemoptysis-related mortality (0.8% vs. 3.2%; OR 0.20, 95% CI 0.05-0.84) compared with conservative treatment alone. There was no significant difference in all-cause mortality between the two groups. In terms of security, the incidence of major complications and minor complications in patients undergoing BAE treatment was 0.2% (1/422) and 15.6%, respectively. CONCLUSIONS BAE was more effective than conservative treatment alone in controlling hemoptysis, reducing recurrence, and decreasing hemoptysis-related mortality, with an almost negligible risk of major complications.
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Affiliation(s)
- Shengxin Fan
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Xiaocheng Cheng
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Xiaohui Wang
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Yuliang Liu
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Wei He
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
| | - Hong Chen
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
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Lin Q, Chen J, Yu T, Gao B, Kuang K, Fan Y, Xu J, Li X, Lin X, Xu L. Risk factors for the recurrence in pulmonary tuberculosis patients with massive hemoptysis. THE CLINICAL RESPIRATORY JOURNAL 2023. [PMID: 37406999 PMCID: PMC10363826 DOI: 10.1111/crj.13653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/29/2023] [Accepted: 06/11/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVES To evaluate the outcomes of bronchial artery embolization (BAE) for the treatment of massive hemoptysis in patients with pulmonary tuberculosis and identify risk factors that influence recurrence. METHODS A total of 81 patients with massive hemoptysis who underwent BAE between January 2014 and December 2017 were retrospectively reviewed. All of the patients had either a history of pulmonary tuberculosis or a current diagnosis of pulmonary tuberculosis. Follow-up ranged from 18 to 66 months. RESULTS Hemoptysis was stopped or markedly decreased, with subsequent clinical improvement in 73 patients, while 11 patients experienced recurrence during the follow-up period. Systemic-pulmonary shunts and clinical failure showed a statistically significant correlation with the recurrence rate. The cumulative non-recurrence rate was 95.3% for 3 months and 81.9% for more than 24 months. Complications were common (12.5%), but self-limiting. CONCLUSIONS BAE is a safe and effective treatment option for the control of massive hemoptysis in pulmonary tuberculosis patients. Systemic-pulmonary shunts and clinical failure are the risk factors for recurrence.
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Affiliation(s)
- Qiong Lin
- Department of Respiratory Medicine, Fuzhou No.1 Hospital Affiliated with Fujian Medical University, Fuzhou, Fujian, China
| | - Jian Chen
- Department of Intervention Therapy, Fuzhou No.1 Hospital Affiliated with Fujian Medical University, Fuzhou, Fujian, China
| | - Tianxing Yu
- Department of Respiratory Medicine, Fuzhou No.1 Hospital Affiliated with Fujian Medical University, Fuzhou, Fujian, China
| | - Bing Gao
- Department of Medical Imaging, Fuzhou Second Hospital of Xiamen University (Fuzhou Second Hospital), Fuzhou, Fujian, China
| | - Kaijin Kuang
- School of Finance, Fujian Jiangxia University, Fuzhou, Fujian, China
| | - Yong Fan
- Cent Lab, Fuzhou No.1 Hospital Affiliated with Fujian Medical University, Fuzhou, Fujian, China
| | - Junping Xu
- Department of Respiratory Medicine, Fuzhou No.1 Hospital Affiliated with Fujian Medical University, Fuzhou, Fujian, China
| | - Xiaohua Li
- Department of Respiratory Medicine, Fuzhou No.1 Hospital Affiliated with Fujian Medical University, Fuzhou, Fujian, China
| | - Xin Lin
- Department of Respiratory Medicine, Fuzhou No.1 Hospital Affiliated with Fujian Medical University, Fuzhou, Fujian, China
| | - Liyu Xu
- Department of Respiratory Medicine, Fuzhou No.1 Hospital Affiliated with Fujian Medical University, Fuzhou, Fujian, China
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Yan HT, Lu GD, Liu J, Liu S, Shi HB, Zhou CG, Zu QQ. Does the presence of systemic artery-pulmonary circulation shunt during bronchial arterial embolization increase the recurrence of noncancer-related hemoptysis? A retrospective cohort study. Respir Res 2023; 24:119. [PMID: 37131263 PMCID: PMC10152774 DOI: 10.1186/s12931-023-02427-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 04/19/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND The presence of systemic artery-pulmonary circulation shunt (SPS) during the bronchial arterial embolization (BAE) procedure, has been inferred to be a potential risk factor for recurrence. The aim of this study is to reveal the impact of SPS on the recurrence of noncancer-related hemoptysis after BAE. METHODS In this study, 134 patients with SPS (SPS-present group) and 192 patients without SPS (SPS-absent group) who underwent BAE for noncancer-related hemoptysis from January 2015 to December 2020 were compared. Four different Cox proportional hazards regression models were used to clarify the impact of SPSs on hemoptysis recurrence after BAE. RESULTS During the median follow-up time of 39.8 months, recurrence occurred in 75 (23.0%) patients, including 51 (38.1%) in the SPS-present group and 24 (12.5%) in the SPS-absent group. The 1-month, 1-year, 2-year, 3-year and 5-year hemoptysis-free survival rates in the SPS-present and SPS-absent groups were 91.8%, 79.7%, 70.6%, 62.3%, and 52.6% and 97.9%, 94.7%, 89.0%, 87.1%, and 82.3%, respectively (P < 0.001). The adjusted hazard ratios of SPSs in the four models were 3.37 [95% confidence intervals (CI), 2.07-5.47, P < 0.001 in model 1], 1.96 (95% CI, 1.11-3.49, P = 0.021 in model 2), 2.29 (95% CI, 1.34-3.92, P = 0.002 in model 3), and 2.39 (95% CI, 1.44-3.97, P = 0.001 in model 4). CONCLUSIONS The presence of SPS during BAE increases the recurrence probability of noncancer-related hemoptysis after BAE.
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Affiliation(s)
- Hai-Tao Yan
- Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China
| | - Guang-Dong Lu
- Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China
| | - Jin Liu
- Department of Clinical Medicine Research Institution, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - Sheng Liu
- Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China
| | - Hai-Bin Shi
- Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China.
| | - Chun-Gao Zhou
- Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China.
| | - Qing-Quan Zu
- Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China.
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Yan HT, Lu GD, Zhang JX, Zhou CG, Liu J, Liu S, Shi HB, Zu QQ. Comparison of Bronchial Artery Embolisation Versus Conservative Treatment for Bronchiectasis-Related Nonmassive Haemoptysis: A Single-Centre Retrospective Study. Cardiovasc Intervent Radiol 2023; 46:369-376. [PMID: 36658375 DOI: 10.1007/s00270-023-03361-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/04/2023] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To compare the safety and effectiveness between bronchial artery embolisation (BAE) and conservative treatment for bronchiectasis-related nonmassive haemoptysis patients. MATERIALS AND METHODS From January 2015 to December 2020, consecutive bronchiectasis-related nonmassive haemoptysis patients who underwent either BAE (n = 98) or conservative treatment (n = 118) were included. Treatment-related complications, length of hospital stays, clinical success rate, patient satisfaction, and recurrence-free survival rates were compared between groups. Prognostic factors related to recurrence were also analysed. RESULTS During a median follow-up time of 44.8 months (range, 2.4-83.6 months), 34 and 66 patients in the BAE and conservative treatment groups suffered relapse. The 1-year, 2-year, 3-year and 5-year haemoptysis-free survival rates in the BAE and conservative treatment groups were 79.2%, 68.1%, 62.8%, and 57.6% and 64.0%, 52.8%, 44.1%, and 37.0%, respectively (P = 0.007). The minor complication rate after BAE was higher than that after conservative treatment (23/98 vs. 12/118, P = 0.008). BAE was associated with shorter hospital stays (5.0 vs. 7.0 days, P = 0.042) and higher patient satisfaction (88.8% vs. 74.6%, P = 0.008) than those for conservative treatment and with comparable clinical success rates (95.9% vs. 91.5%, P = 0.192). Treatment type, haemoptysis duration, and bronchiectasis severity were independently significant predictors of recurrence for these patients. CONCLUSIONS BAE could be another option for bronchiectasis-related nonmassive haemoptysis patients. In the patients with longer duration and more severe bronchiectasis, BAE still appeared to have better long-term haemoptysis control than conservative therapy.
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Affiliation(s)
- Hai-Tao Yan
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, 210029, China
| | - Guang-Dong Lu
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, 210029, China
| | - Jin-Xing Zhang
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, 210029, China
| | - Chun-Gao Zhou
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, 210029, China
| | - Jin Liu
- Department of Clinical Medicine Research Institution, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China
| | - Sheng Liu
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, 210029, China
| | - Hai-Bin Shi
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, 210029, China
| | - Qing-Quan Zu
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, 210029, China.
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Role of Bronchial Artery Embolization as Early Treatment Option in Stable Cystic Fibrosis Patients with Sub-Massive Hemoptysis: Personal Experience and Literature Review. J Clin Med 2022; 11:jcm11216432. [PMID: 36362659 PMCID: PMC9657817 DOI: 10.3390/jcm11216432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/19/2022] [Accepted: 10/27/2022] [Indexed: 11/22/2022] Open
Abstract
(1) Background: We describe our experience with cystic fibrosis (CF) patients treated with bronchial artery embolization (BAE) for sub-massive hemoptysis to understand if early treatment of sub-massive hemoptysis can reduce the volume of any subsequent bleedings. (2) Materials: We performed a retrospective study including CF patients who underwent angiographic procedures for BAE following sub-massive hemoptysis, from March 2016 to December 2021. All patients underwent an initial chest angio-CT study. BAE was realized with microspheres or coils. (3) Results: Thirteen patients were included, subjected to at least one BAE after sub-massive hemoptysis, for a total of 19 procedures. Technical success was 94.7%; in a single case, the catheterization of the bronchial arterial feeder was not achievable and the procedure was repeated. Primary clinical success was 92.3%; secondary clinical success was 69.2%. Relative clinical success was 85%. A higher incidence of recurrent hemoptysis following treatment with coils was observed (100% of cases) compared to treatment with microspheres (54.5% of cases) χ2 = 5.43 (p < 0.05). (4) Conclusions: BAE is a safe and effective method for the treatment of hemoptysis in CF patients; it should be practiced not only after massive or recurrent hemoptysis but also in patients with sub-massive bleeding to improve their life expectancy and quality of life.
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Lee JH, Yoon CJ, Jung YS, Choi WS, Lee CH, Lee GM. Comparison of n-butyl-2-cyanoacrylate and polyvinyl alcohol particles for bronchial artery embolisation in primary lung cancer: a retrospective cohort study. Respir Res 2022; 23:257. [PMID: 36127690 PMCID: PMC9487124 DOI: 10.1186/s12931-022-02183-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 09/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bronchial artery embolisation (BAE) is an effective treatment option to control haemoptysis in primary lung cancer. However, no studies have investigated optimal embolisation material for BAE in lung cancer patients. Thus, this study aimed to compare the safety and efficacy of BAE performed using n-butyl-2-cyanoacrylate (NBCA) and polyvinyl alcohol (PVA) particles in primary lung cancer patients to determine which embolic material is better for patients with haemoptysis. METHODS This retrospective study was approved by the institutional review board, and consent was waived. The rates of hemostasis, complications, procedure time, dose-area product, and haemoptysis-free survival were retrospectively compared between primary lung cancer (non-small cell [n = 111] and small cell [n = 11]) patients who underwent BAE using NBCA (n = 58) or PVA particles (n = 64) between January 2004 and December 2019. Predictors of recurrent haemoptysis were analysed using the Cox proportional hazard regression model. RESULTS Among 122 patients (mean age, 66 ± 10 years; range 32-86 years; 103 men), more patients in the NBCA group (81.0%; 47 of 58) achieved complete hemostasis than did patients in the PVA group (53.1%; 34 of 64) (P = 0.002). No major complications were observed in either group. The procedure time (36.4 ± 21.6 vs. 56.3 ± 27.4 min, P < 0.001) was shorter, and the dose-area product (58.6 ± 64.0 vs. 233.5 ± 225.0 Gy*cm2, P < 0.001) was smaller in the NBCA group than in the PVA group. The median haemoptysis-free survival was 173.0 in the NBCA group compared with 20.0 days in the PVA group (P < 0.001). The PVA use (P < 0.001) and coagulopathy (P = 0.014) were independent predictors of shortened haemoptysis-free survival. CONCLUSION BAE using NBCA showed significantly superior initial hemostasis with longer haemoptysis-free survival, shorter procedure time, and reduced radiation dose than BAE using PVA particles. The PVA use and coagulopathy were independent predictors of recurrent haemoptysis. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- Jae Hwan Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.,Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Chang Jin Yoon
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea. .,Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.
| | - Yun Su Jung
- Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Won Seok Choi
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.,Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Chong-Ho Lee
- Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Guy Mok Lee
- Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
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Yang Q, cheng Luo L, Wei H, Yi Q, Luo W. Dual-vessel intervention treatment for massive hemoptysis caused by lung cavitary lesions. Eur J Radiol 2022; 154:110448. [DOI: 10.1016/j.ejrad.2022.110448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 06/29/2022] [Accepted: 07/19/2022] [Indexed: 11/30/2022]
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8
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Bawaadam H, Romero AO, Krishna G. Therapeutic Use of Robotic Bronchoscopy System to Treat Chronic Invasive Pulmonary Aspergillosis. J Bronchology Interv Pulmonol 2022; 29:e35-e38. [PMID: 35730783 DOI: 10.1097/lbr.0000000000000773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Hasnain Bawaadam
- Section of Interventional Pulmonary Division of Pulmonary, Critical Care Allergy and Sleep Medicine, University of California San Francisco, San Francisco
| | - Arthur O Romero
- Department of Medicine, Division of Pulmonary and Critical Care, University of Nevada Las Vegas, Las Vegas, NV
| | - Ganesh Krishna
- Section of Interventional Pulmonary Division of Pulmonary, Critical Care Allergy and Sleep Medicine, University of California San Francisco, San Francisco.,Department of Medicine, Division of Pulmonary and Critical Care, Palo Alto Medical Foundation, Palo Alto, CA
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9
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Yan HT, Lu GD, Huang XZ, Zhang DZ, Ge KY, Zhang JX, Liu J, Liu S, Shi HB, Zu QQ. Development of a model to predict recurrence after bronchial artery embolization for non-cancer related hemoptysis. BMC Pulm Med 2021; 21:419. [PMID: 34922497 PMCID: PMC8684203 DOI: 10.1186/s12890-021-01790-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 12/06/2021] [Indexed: 11/10/2022] Open
Abstract
Background Relapse after effective bronchial arterial embolization (BAE) for controlling hemoptysis is not uncommon. Studies reported diverse predictors of recurrence. However, a model to assess the probability of recurrence in non-cancer related hemoptysis patients after BAE has not been reported. This study was to develop a model to predict recurrence after BAE for non-cancer related hemoptysis. Methods The study cohort included 487 patients who underwent BAE for non-cancer-related hemoptysis between January 2015 and December 2019. We derived the model’s variables from univariate and multivariate Cox regression analyses. The model presented as a nomogram scaled by the proportional regression coefficient of each predictor. Model performance was assessed with respect to discrimination and calibration. Results One-month and 1-, 2-, 3- and 5-year recurrence-free rates were 94.5%, 88.0%, 81.4%, 76.2% and 73.8%, respectively. Risk factors for recurrence were underlying lung diseases and the presence of systemic arterial-pulmonary circulation shunts. This risk prediction model with two risk factors provided good discrimination (area under curve, 0.69; 95% confidence interval, 0.62–0.76), and lower prediction error (integrated Brier score, 0.143). Conclusion The proposed model based on routinely available clinical and imaging features demonstrates good performance for predicting recurrence of non-cancer-related hemoptysis after BAE. The model may assist clinicians in identifying higher-risk patients to improve the long-term efficacy of BAE.
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Affiliation(s)
- Hai-Tao Yan
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China
| | - Guang-Dong Lu
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China
| | - Xiang-Zhong Huang
- Department of Interventional Radiology, Jiangyin People's Hospital, Wuxi, 214400, China
| | - Da-Zhong Zhang
- Department of Interventional Radiology, Jiangsu Taizhou People's Hospital, Taizhou, 225300, China
| | - Kun-Yuan Ge
- Department of Interventional Radiology, Yixing People's Hospital, Wuxi, 214200, China
| | - Jin-Xing Zhang
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China
| | - Jin Liu
- Department of Clinical Medicine Research Institution, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - Sheng Liu
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China
| | - Hai-Bin Shi
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China.
| | - Qing-Quan Zu
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China.
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Xiaobing L, Meipan Y, Pengfei X, Yue Z, Ying L, Xiangnan L, Yu Q, Yaozhen M, Chunxia L, Gang W. Bronchial Artery Chemoembolization for Hemoptysis in Advanced Primary Lung Cancer. Clin Lung Cancer 2021; 23:e203-e209. [PMID: 34824012 DOI: 10.1016/j.cllc.2021.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 10/06/2021] [Accepted: 10/10/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND To evaluate the safety and effectiveness of bronchial arterial infusion chemoembolization (BAICE) for lung cancer with hemoptysis. PATIENTS AND METHODS Retrospectively analyze clinical data of patients undergoing BAICE for the treatment of lung cancer with hemoptysis, evaluate the clinical efficacy of this approach, observe postoperative adverse reactions, and analyze hemoptysis-free survival (HFS) and overall survival (OS). RESULTS All 187 patients underwent BAICE with technical success rate of 100%, clinical success rate of 86.6%, clinical failure rate of 13.4%. After BAICE, the tumor curative effect was evaluated as complete remission in 56 cases, partial remission in 82 cases, stable disease in 26 cases, and progressive disease in 6 cases. The objective response rate was 73.8%, and the disease control rate was 87.7%. Median HFS of the 154 clinically successful cases was 10.5 months (95% confidence interval [CI]: 8.11-11.89). The degree of hemoptysis (massive hemoptysis hazard ratio [HR] = 5.9, 95% CI: 3.43-10.16, P = .00) and cavitary lung mass (HR = 2.39, 95% CI: 1.44-3.99, P = .001), were significantly related to a reduction in HFS after BAICE. The 6-month and 12-month survival rates were 66.5% and 45.6%, respectively. The median OS of clinically successful cases was 13.0 months (95% CI: 11.22-14.77). The median OS of 16 clinically failed cases was 2.0 months (95% CI: 0.41-2.45) (P < .001). All adverse events were grade 1. CONCLUSION BAICE for advanced lung cancer with hemoptysis is safe, effective, and tolerable.
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Affiliation(s)
- Li Xiaobing
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yin Meipan
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Xie Pengfei
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Zhao Yue
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Liu Ying
- Department of Respiratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Li Xiangnan
- Departments of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Qi Yu
- Departments of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Ma Yaozhen
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Li Chunxia
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Wu Gang
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
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11
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Semasinghe Bandaralage SP, Tay G, Hay K, Megram E, Smith D, Gadowski T, Wright E, France M, Bell S, Reid D. Outcomes of artery embolisation for cystic fibrosis patients with haemoptysis: a 20-year experience at a major Australian tertiary centre. Intern Med J 2021; 51:1526-1529. [PMID: 34541776 DOI: 10.1111/imj.15483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 02/12/2021] [Accepted: 02/15/2021] [Indexed: 11/30/2022]
Abstract
There are no published data on Australian adult cystic fibrosis (CF) patient outcomes post bronchial arterial embolisation (BAE). We report 20 years of experience of BAE at a major Australian tertiary adult CF centre, where 46 patients underwent 100 BAE during this period. Mortality rate was comparable to previous studies (4% per year) and most who died had repeat BAE requirements. A higher proportion (9 out of 45) of patients were transplanted compared to previous publications. Repeat BAE was common and significantly higher in patients already on tranexamic acid.
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Affiliation(s)
- Sahan P Semasinghe Bandaralage
- Respiratory Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - George Tay
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Karen Hay
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Emma Megram
- Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Daniel Smith
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Tahlia Gadowski
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Eimear Wright
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Megan France
- Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Scott Bell
- Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia.,Lung Bacteria Group, Child Health Research Centre - University of Queensland, Brisbane, Queensland, Australia
| | - David Reid
- Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
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12
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Dohna M, Renz DM, Stehling F, Dohna-Schwake C, Sutharsan S, Neurohr C, Wirtz H, Eickmeier O, Grosse-Onnebrink J, Sauerbrey A, Soditt V, Poplawska K, Wacker F, Montag MJ. Coil embolisation for massive haemoptysis in cystic fibrosis. BMJ Open Respir Res 2021; 8:8/1/e000985. [PMID: 34385150 PMCID: PMC8362706 DOI: 10.1136/bmjresp-2021-000985] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 07/26/2021] [Indexed: 12/01/2022] Open
Abstract
Introduction Massive haemoptysis is a life-threatening event in advanced cystic fibrosis (CF) lung disease with bronchial artery embolisation (BAE) as standard of care treatment. The aim of our study was to scrutinise short-term and long-term outcomes of patients with CF and haemoptysis after BAE using coils. Methods We carried out a retrospective cohort study of 34 adult patients treated for massive haemoptysis with super selective bronchial artery coil embolisation (ssBACE) between January 2008 and February 2015. Embolisation protocol was restricted to the culprit vessel(s) and three lobes maximum. Demographic data, functional end-expiratory volume in 1 s in % predicted (FEV1% pred.) and body mass index before and after ssBACE, sputum colonisation, procedural data, time to transplant and time to death were documented. Results Patients treated with ssBACE showed significant improvement of FEV1% pred. after embolisation (p=0.004) with 72.8% alive 5 years post-ssBACE. Mean age of the patients was 29.9 years (±7.7). Mean FEV1% pred. was 45.7% (±20.1). Median survival to follow-up was 75 months (0–125). Severe complication rate was 0%, recanalisation rate 8.8% and 5-year-reintervention rate 58.8%. Chronic infection with Pseudomonas aeruginosa was found in 79.4%, Staphylococcus areus in 50% and Aspergillus fumigatus in 47.1%. Discussion ssBACE is a safe and effective treatment for massive haemoptysis in patients with CF with good results for controlling haemostasis and excellent short-term and long-term survival, especially in severely affected patients with FEV<40% pred. We think the data of our study support the use of coils and a protocol of careful and prudent embolisation.
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Affiliation(s)
- Martha Dohna
- Pediatric Radiology, Hannover Medical School, Hannover, Germany
| | | | - Florian Stehling
- Department of Pediatric Pulmonology and Sleep Medicine, University Hospital Essen, Essen, Germany
| | | | | | - Claus Neurohr
- Robert-Bosch-Krankenhaus Klinik Schillerhohe, Gerlingen, Germany
| | - Hubert Wirtz
- Department of Respiratory Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Olaf Eickmeier
- Department of Pneumology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | | | | | - Volker Soditt
- Pediatrics, Stadtisches Klinikum Solingen, Solingen, Germany
| | - Krystyna Poplawska
- Pediatrics, Johannes Gutenberg University Hospital Mainz, Mainz, Germany
| | - Frank Wacker
- Radiology, Hannover Medical School, Hannover, Germany
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13
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Prasad BPK, Ray B. Singular observation of a desirable change after bronchial artery embolization for hemoptysis in intracavitary aspergilloma. Indian J Radiol Imaging 2021; 27:225-228. [PMID: 28744084 PMCID: PMC5510321 DOI: 10.4103/ijri.ijri_335_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aspergillomas are fungal balls developing in pre-existing lung cavities, which are most commonly secondary to tuberculosis. Aspergillomas can cause hemoptysis due to erosion of the blood vessels in cavity walls, which can often be recurrent, massive, and life-threatening. Bronchial artery embolization is considered to be the treatment of choice for short-term control of hemoptysis, and lobectomy as the definitive treatment for aspergilloma. We present a unique observation in two cases of aspergilloma where the fungal balls disappeared radiologically after bronchial artery embolization performed for massive hemoptysis.
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Affiliation(s)
- B P K Prasad
- Department of Interventional Radiology, Rajagiri Hospital, Kochi, Kerala, India
| | - Brijesh Ray
- Department of Imaging and Interventional Radiology, Aster Medcity Hospital, Kochi, Kerala, India
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14
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Yan HT, Lu GD, Huang XZ, Zhang DZ, Ge KY, Zhang JX, Liu J, Liu S, Zu QQ, Shi HB. A Nomogram to Predict Recurrence After Bronchial Artery Embolization for Hemoptysis Due to Bronchiectasis. Cardiovasc Intervent Radiol 2021; 44:1609-1617. [PMID: 34282490 DOI: 10.1007/s00270-021-02923-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/10/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To develop and validate a nomogram for predicting recurrent hemoptysis after successful bronchial arterial embolization (BAE) in patients with bronchiectasis. MATERIALS AND METHODS From January 2015 to December 2019, a total of 251 patients were enrolled in this study. A nomogram was developed with the predictors of recurrent events, which were identified by univariate and multivariate Cox regression analyses. We evaluated nomogram discrimination by area under the receiver operating characteristic curve, calibration by the calibration curve, and clinical usefulness potential by decision curve analysis. RESULTS The one-month, 1-year, 2-year, 3-year, and 5-year cumulative recurrence-free rates of patients were 98.4%, 90.5%, 82.8%, 77.7%, and 74.4%, respectively. Three predictive factors, namely sex, lung destruction, and systemic arterial-pulmonary circulation shunts, were applied to develop the nomogram. The model maintained good discrimination (area under the curve, 0.72; 95% confidence interval, 0.62-0.81), low prediction error (integrated Brier score, 0.129), and certain net benefits in terms of clinical usefulness. CONCLUSIONS The proposed nomogram showed favorable predictive efficacy for hemoptysis recurrence after BAE in patients with bronchiectasis. Improved long-term outcomes are expected with close follow-up, a healthy lifestyle, and pulmonary rehabilitation for patients at risk of recurrence according to the model.
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Affiliation(s)
- Hai-Tao Yan
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China
| | - Guang-Dong Lu
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China
| | - Xiang-Zhong Huang
- Department of Interventional Radiology, Jiangyin People's Hospital, Wuxi, 214400, China
| | - Da-Zhong Zhang
- Department of Interventional Radiology, Jiangsu Taizhou People's Hospital, Taizhou, 225300, China
| | - Kun-Yuan Ge
- Department of Interventional Radiology, Yixing People's Hospital, Wuxi, 214200, China
| | - Jin-Xing Zhang
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China
| | - Jin Liu
- Department of Clinical Medicine Research Institution, The First Affiliated Hospital With Nanjing Medical University, Nanjing, 210029, China
| | - Sheng Liu
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China
| | - Qing-Quan Zu
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China.
| | - Hai-Bin Shi
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China.
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15
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Choi WS, Kim MU, Kim HC, Yoon CJ, Lee JH. Variations of bronchial artery origin in 600 patients: Systematic analysis with multidetector computed tomography and digital subtraction angiography. Medicine (Baltimore) 2021; 100:e26001. [PMID: 34087845 PMCID: PMC8183775 DOI: 10.1097/md.0000000000026001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 04/24/2021] [Indexed: 01/04/2023] Open
Abstract
To identify and evaluate the spectrum and prevalence of variations in bronchial artery (BA) origin by multidetector computed tomography (MDCT) and digital subtraction angiography (DSA) in a large population with hemoptysis.From July 2008 to June 2015, data from 600 individuals with hemoptysis who underwent MDCT and DSA were retrospectively analyzed. The pattern of BA origin was investigated and classified according to distribution.A total of 1674 BAs were evaluated, 866 were right BA and 808 were left BA. Most BAs originated from the upper descending thoracic aorta, classified as orthotopic origin (n = 1464, 87.5%). Among ectopic origin BAs (n = 210, 12.5%), concavity of the aortic arch was the most common (n = 107). The most common distribution pattern was a single artery in each side (n = 262). According to our classification, Type I was most common (n = 457), including BAs originating in orthotopic fashion from the descending thoracic aorta. Type II (n = 2) was defined as BAs originating from the aortic arch or ascending aorta. Type III (not found) was defined as BAs originating from subclavian arteries, common carotid arteries, and their branch vessels. Type IV (n = 92) was Type I and II combined, Type V (n = 41) was Type I and III combined, Type VI (not found) was Type II and III combined, and Type VII (n = 8) was Type I, II, and III combined.Variations of BA origin could be systematically described in detail.
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Affiliation(s)
- Won Seok Choi
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do
| | - Min Uk Kim
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital
| | - Chang Jin Yoon
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do
- Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae Hwan Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do
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16
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Lee HN, Park HS, Hyun D, Cho SK, Park KB, Shin SW, Soo Do Y. Combined therapy with bronchial artery embolization and tranexamic acid for hemoptysis. Acta Radiol 2021; 62:610-618. [PMID: 32551802 DOI: 10.1177/0284185120933984] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND While most previous studies have viewed tranexamic acid as a bridging or temporary therapy, our preliminary study offers insights into the combined therapy of antifibrinolytic agent with endovascular treatment for hemoptysis. PURPOSE To investigate the feasibility and safety of combined therapy, to analyze factors affecting the outcomes of combined therapy, and to compare the effectiveness of combined therapy between groups with different etiologies. MATERIAL AND METHODS Between January 2011 and December 2014, 64 patients (33 men, mean age 64.6 years) underwent combined therapy for hemoptysis. The median follow-up time was 14.7 months (range 174-2435 days). Patients were divided into a tuberculosis group (GroupTB, n=37) and a non-tuberculosis group (Groupnon-TB, n=27). RESULTS Embolotherapy was technically successful in 62/64 (96.9%) cases. The immediate clinical success rate was 96.8% (60/62). The short-term and long-term recurrence rates were 12.9% (n=8) and 19.4% (n=12), respectively. The one-, two-, and four-year recurrence-free survival rates were 61%, 49%, and 32%, respectively. There was no significant survival difference between the two groups. Suboptimal embolization was a significant risk factor for immediate clinical failure (odds ratio 29.624, P = 0.023). Optimal embolization (hazard ratio [HR] 0.199, P = 0.023) and older age (HR 0.956, P = 0.013) were significantly associated with lower recurrence risk. CONCLUSION Combined therapy is an effective and safe treatment modality for hemoptysis of various etiologies, with potential benefits for short-term recurrence vis-a-vis current literature evidence. Suboptimal embolization was the most important modifiable risk factor for treatment failure and recurrence after combined therapy.
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Affiliation(s)
- Hyoung Nam Lee
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan-si, Republic of Korea
| | - Hong Suk Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dongho Hyun
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Ki Cho
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kwang Bo Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Wook Shin
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Soo Do
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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17
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Bronchial Artery Embolisation for Massive Haemoptysis: Immediate and Long-Term Outcomes-A Retrospective Study. Pulm Ther 2020; 6:107-117. [PMID: 32185642 PMCID: PMC7229022 DOI: 10.1007/s41030-020-00112-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Indexed: 12/24/2022] Open
Abstract
Introduction Bronchial artery embolisation (BAE) is an established treatment method for massive haemoptysis. The aim of this study is to evaluate the impact of BAE on in-hospital outcomes and long-term survival in patients with massive haemoptysis. Methods Retrospective review of all cases of acute massive haemoptysis treated by BAE between April 2000 and April 2012 with at least a 5 year follow up of each patient. Targeted BAE was performed in cases with lateralising symptoms, bronchoscopic sites of bleeding or angiographic unilateral abnormal vasculature. In the absence of lateralising symptoms or signs, bilateral BAE was performed. Results 96 BAEs were performed in 68 patients. The majority (64 cases, 67%) underwent unilateral procedures. 83 (86.5%) procedures resulted in immediate/short term control of haemoptysis which lasted for longer than a month. The mean duration of haemoptysis free period after embolisation was 96 months. There were three major complications (cardio-pulmonary arrest, paraparesis and stroke). 38 (56%) patients were still alive at least 5 years following their BAE. Benign causes were associated with significantly longer haemoptysis free periods, mean survival 108 months compared to 32 months in patients with an underlying malignant cause (p = 0.005). An episode of haemoptysis within a month of the initial embolisation was associated reduced overall survival (p = 0.033). Conclusion BAE is effective in controlling massive haemoptysis. Long-term survival depends on the underlying pulmonary pathology. Strategies are required to avoid incomplete initial embolisation, which is associated with ongoing haemoptysis and high mortality despite further BAE.
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18
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Martin LN, Higgins L, Mohabir P, Sze DY, Hofmann LV. Bronchial Artery Embolization for Hemoptysis in Cystic Fibrosis Patients: A 17-Year Review. J Vasc Interv Radiol 2019; 31:331-335. [PMID: 31899109 DOI: 10.1016/j.jvir.2019.08.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 08/21/2019] [Accepted: 08/28/2019] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To review safety and efficacy of bronchial artery embolization (BAE) for treatment of hemoptysis in adult patients with cystic fibrosis (CF) and to report 30-day, 1-year, and 3-year outcomes. MATERIALS AND METHODS Between January 2001 and April 2018, 242 patients with CF were evaluated for hemoptysis. Thirty-eight BAEs were performed in 28 patients with hemoptysis. Technical success was defined as freedom from repeat embolization and hemoptysis-related mortality. Clinical success was defined as freedom from repeat embolization and mortality from any cause. Technical and clinical success were examined at 30 days, 1 year, and 3 years after initial BAE. Mean patient age was 32 years, and median follow-up was 4.8 years (range, 10 mo to 16.7 y). RESULTS Technical and clinical success rates at 30 days were 89% (25/28) and 82% (23/28), respectively. Success rates at 1 year were 86% (24/28) and 79% (22/28), respectively, and at 3 years were 82% (23/28) and 75% (21/28), respectively. The 30-day overall complication rate was 7.9% (3/38) with 2.6% (1/38) major complication rate and 5.2% (2/38) minor complication rate. Overall 3-year mortality rate was 25% (7/28). CONCLUSIONS BAE is safe and effective in patients with CF presenting with life-threatening hemoptysis. BAE results in high rates of long-term technical and clinical success in this patient population despite progressive chronic disease. Repeat embolization is necessary only in a minority of patients.
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Affiliation(s)
- Lynne N Martin
- Division of Interventional Radiology, Stanford Medicine, 300 Pasteur Drive, H3630, Stanford, CA 94305.
| | - Luke Higgins
- Division of Interventional Radiology, Stanford Medicine, 300 Pasteur Drive, H3630, Stanford, CA 94305
| | - Paul Mohabir
- Division of Pulmonary and Critical Care Medicine, Stanford Medicine, 300 Pasteur Drive, H3630, Stanford, CA 94305
| | - Daniel Y Sze
- Division of Interventional Radiology, Stanford Medicine, 300 Pasteur Drive, H3630, Stanford, CA 94305
| | - Lawrence V Hofmann
- Division of Interventional Radiology, Stanford Medicine, 300 Pasteur Drive, H3630, Stanford, CA 94305
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Lorenz JM, Navuluri R. Embolization of Chest Neoplasms: The Next Frontier in Interventional Oncology? Semin Intervent Radiol 2019; 36:176-182. [PMID: 31435125 DOI: 10.1055/s-0039-1692658] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The management of chest tumors and their sequelae has been an uncommon indication for transarterial embolization (TAE). More recently, vascular embolization has been increasingly performed for this indication. The most common reported indication for embolization of neoplastic disease in the chest is the control of bleeding resulting either from iatrogenic causes or from tumor invasion into a bronchus or vessel. A natural extension of the application of TAE to neoplasm-related hemoptysis is its burgeoning indication as a possible primary treatment for benign chest tumors, primary lung neoplasms, and metastatic disease in patients that are refractory to systemic therapies and have limited or no surgical options. The goals for this indication are tumor regression and management of bulk-related symptoms. In addition to bland TAE for this indication, authors have reported very initial results applying transarterial chemoembolization (TACE) and transarterial radioembolization (TARE) to chest neoplasms with promising results that support feasibility and safety. This article is an up-to-date review of the management of chest tumors with embolization and its variants.
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Affiliation(s)
- Jonathan M Lorenz
- Department of Radiology, The University of Chicago Medical Center, Chicago, Illinois
| | - Rakesh Navuluri
- Department of Radiology, The University of Chicago Medical Center, Chicago, Illinois
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20
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Lu GD, Zhang JX, Zhou CG, Xia JG, Liu S, Zu QQ, Shi HB. Arterial embolization for hemoptysis in patients with chronic pulmonary tuberculosis and in patients with bronchiectasis. Acta Radiol 2019; 60:866-872. [PMID: 30282481 DOI: 10.1177/0284185118805258] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Guang-Dong Lu
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Jin-Xing Zhang
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Chun-Gao Zhou
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Jin-Guo Xia
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Sheng Liu
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Qing-Quan Zu
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Hai-Bin Shi
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
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21
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Bronchial arterial embolization using a gelatin sponge for hemoptysis from pulmonary aspergilloma: comparison with other pulmonary diseases. Emerg Radiol 2019; 26:501-506. [PMID: 31129737 DOI: 10.1007/s10140-019-01695-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/07/2019] [Accepted: 05/13/2019] [Indexed: 01/20/2023]
Abstract
PURPOSE To evaluate the clinical outcomes of bronchial artery embolization (BAE) using a gelatin sponge for hemoptysis from pulmonary aspergilloma and compare them with treatment outcomes for hemoptysis from other diseases. METHODS Fifty-two patients underwent BAE using a gelatin sponge. The etiology of hemoptysis was pulmonary aspergilloma in 8 (PA group) and other diseases in 44 (control group). The technical success rate, clinical success rate, hemoptysis-free rate, and complication rate were compared between the PA group and control group. Technical success was defined as the complete cessation of the targeted feeding artery as confirmed by digital subtraction angiography, and clinical success as the cessation of hemoptysis within 24 h of BAE. Recurrent hemoptysis was defined as a single or multiple episodes of hemoptysis causing > 30 ml of bleeding per day. RESULTS Technical and clinical success rates were 100% in both groups. Hemoptysis-free rates were 85% at 6 months and 72% at 12-60 months in the control group, and 38% at 6-12 months and 25% thereafter in the PA group (P = 0.0009). No complications were observed following BAE in any case in the two groups. CONCLUSION BAE using a gelatin sponge may not be effective for hemoptysis from pulmonary aspergilloma.
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22
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Han K, Yoon KW, Kim JH, Kim GM. Bronchial Artery Embolization for Hemoptysis in Primary Lung Cancer: A Retrospective Review of 84 Patients. J Vasc Interv Radiol 2019; 30:428-434. [PMID: 30819488 DOI: 10.1016/j.jvir.2018.08.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 08/04/2018] [Accepted: 08/19/2018] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To evaluate the safety and efficacy of bronchial artery embolization (BAE) in patients with primary lung cancer-related hemoptysis and to identify factors associated with hemoptysis-free survival. METHODS Data from 84 patients with primary lung cancer (non-small cell [n = 74] and small cell [n = 10]) who underwent BAE from 1997 to 2018 for the management of hemoptysis were retrospectively reviewed. Of these, 53 patients had stage IV lung cancer. The hemoptysis volume prior to initial BAE was trivial (blood-tinged sputum) in 21 patients, moderate (< 300 mL per 24 hours) in 34 patients, and massive (> 300 mL per 24 hours) in 29 patients. RESULTS Technical success, defined as the ability to selectively embolize the abnormal vessel, was achieved in 83 patients (98.8%), and clinical success was achieved in 69 (82.1%) patients. Polyvinyl alcohol particles were used to embolize in 51 patients, gelfoam in 15 patients, and gelfoam plus microcoils in 17 patients. Hemoptysis recurred in 20 patients (23.8%) during follow-up. The median hemoptysis-free survival and overall survival periods were both 61 days. In the clinical-success and clinical-failure groups, the median overall survival period was 99 and 9 days, respectively (P < .001). In multivariable analysis, massive hemoptysis (P = .012) and cavitary lung mass (P = .019) were predictive factors for shortened hemoptysis-free survival. CONCLUSIONS BAE is a safe and effective approach to control hemoptysis, although the prognosis in primary lung cancer patients presenting with hemoptysis is generally poor. Massive hemoptysis and cavitary lung mass are significant predictors of shortened hemoptysis-free survival.
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Affiliation(s)
- Kichang Han
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Ki Woong Yoon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Korea
| | - Jin Hyoung Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Korea.
| | - Gyoung Min Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
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Ando T, Kawashima M, Masuda K, Takeda K, Okuda K, Suzuki J, Ohshima N, Horibe M, Tamura A, Nagai H, Matsui H, Ohta K. Exacerbation of chronic pulmonary aspergillosis was associated with a high rebleeding rate after bronchial artery embolization. Respir Investig 2019; 57:260-267. [PMID: 30692051 DOI: 10.1016/j.resinv.2018.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/07/2018] [Accepted: 12/18/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Hemoptysis is a common symptom associated with chronic pulmonary aspergillosis (CPA). While surgery is the primary choice to manage hemoptysis, it is often avoided because patients with CPA are more likely to have complications such as respiratory insufficiency and low pulmonary function. Bronchial artery embolization (BAE) may be considered one of the treatments of massive and persistent hemoptysis for such patients. METHODS We retrospectively reviewed medical records of 41 patients, admitted to National Hospital Organization Tokyo National Hospital, Tokyo, Japan with hemoptysis arising from CPA between January 2011 to December 2016, who were considered inoperable and had undergone BAE. RESULTS Out of the 41 cases analyzed in this study, 21 (51.2%) developed rebleeding after BAE within the mean follow-up duration of 24 months. The non-rebleeding rate of patients after BAE was 92.7% within a month and 65.8% within a year. Patients who developed rebleeding had significantly more non-bronchial systemic arteries responsible for the bleeding compared with patients who did not develop rebleeding (mean of 2.55 vs. 4.86, respectively, P = 0.011). Patients with stable or improved radiological findings demonstrated significantly lower rebleeding rates than those with radiological deterioration (P < 0.001). The non-rebleeding patients had significantly better survival than those with rebleeding (79.7% vs. 39.9% over 5 years, P = 0.046). CONCLUSIONS Bronchial artery embolization was effective in controlling hemoptysis in patients with CPA, especially those who could not undergo surgical resection. However, disease control of CPA was important to prevent rebleeding over the long term and to improve survival after BAE.
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Affiliation(s)
- Takahiro Ando
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose, Tokyo 204-8585, Japan.
| | - Masahiro Kawashima
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose, Tokyo 204-8585, Japan.
| | - Kimihiko Masuda
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose, Tokyo 204-8585, Japan.
| | - Keita Takeda
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose, Tokyo 204-8585, Japan.
| | - Kenichi Okuda
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose, Tokyo 204-8585, Japan.
| | - Junko Suzuki
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose, Tokyo 204-8585, Japan.
| | - Nobuharu Ohshima
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose, Tokyo 204-8585, Japan.
| | - Mitsuko Horibe
- Radiology Department, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose, Tokyo 204-8585, Japan.
| | - Atsuhisa Tamura
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose, Tokyo 204-8585, Japan.
| | - Hideaki Nagai
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose, Tokyo 204-8585, Japan.
| | - Hirotoshi Matsui
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose, Tokyo 204-8585, Japan.
| | - Ken Ohta
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose, Tokyo 204-8585, Japan.
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Singh P, Singh R, Prakash S, Kaur R, Rai R. Anterior spinal cord infarction as a complication of bronchial artery embolization in the management of recurrent hemoptysis. VASCULAR INVESTIGATION AND THERAPY 2019. [DOI: 10.4103/vit.vit_12_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Monroe EJ, Pierce DB, Ingraham CR, Johnson GE, Shivaram GM, Valji K. An Interventionalist's Guide to Hemoptysis in Cystic Fibrosis. Radiographics 2018. [PMID: 29528824 DOI: 10.1148/rg.2018170122] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Massive hemoptysis occurs in a minority of patients with cystic fibrosis, with an annual incidence of 1%. Although rare, massive hemoptysis can be a severe and potentially fatal complication of this disease. Beyond the acute life-threatening event, hemoptysis in patients with cystic fibrosis has been associated with faster decline in lung function, accelerated need for lung transplant, and increased mortality. The bronchial arteries are the culprit vessels in over 90% of cases of hemoptysis. This normally quiescent vascular system undergoes remarkable hypertrophy, collateralization, and angiogenesis before the onset of hemoptysis, introducing numerous pitfalls for the interventionalist. However, in experienced hands, bronchial artery embolization is a safe and potentially lifesaving therapy. Preprocedural noninvasive imaging, specifically computed tomographic angiography, has been repeatedly validated for helping to localize the likely site of bleeding, characterizing pertinent arterial anatomy, and promoting efficient and effective intervention; it has been recommended for all stable patients with hemoptysis. Success in the angiographic suite requires a thorough understanding of normal and variant bronchial arterial anatomy, appropriate patient selection, and a meticulous embolization technique. A meticulous approach to imaging and intervention, conscientious of both visualized and nonvisualized collateral pathways and nontarget vessels, can minimize potentially devastating complications. This review summarizes the current literature, modern procedural techniques, and emerging controversies, serving to guide an evolving approach to management of patients with cystic fibrosis and hemoptysis. ©RSNA, 2018.
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Affiliation(s)
- Eric J Monroe
- From the Department of Radiology, University of Washington, Seattle, Wash (E.J.M., D.B.P., C.R.I., G.E.J., G.M.S., K.V.); and Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, MA.7.220-Radiology, Seattle, WA 98105 (E.J.M., G.M.S.)
| | - David B Pierce
- From the Department of Radiology, University of Washington, Seattle, Wash (E.J.M., D.B.P., C.R.I., G.E.J., G.M.S., K.V.); and Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, MA.7.220-Radiology, Seattle, WA 98105 (E.J.M., G.M.S.)
| | - Christopher R Ingraham
- From the Department of Radiology, University of Washington, Seattle, Wash (E.J.M., D.B.P., C.R.I., G.E.J., G.M.S., K.V.); and Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, MA.7.220-Radiology, Seattle, WA 98105 (E.J.M., G.M.S.)
| | - Guy E Johnson
- From the Department of Radiology, University of Washington, Seattle, Wash (E.J.M., D.B.P., C.R.I., G.E.J., G.M.S., K.V.); and Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, MA.7.220-Radiology, Seattle, WA 98105 (E.J.M., G.M.S.)
| | - Giridhar M Shivaram
- From the Department of Radiology, University of Washington, Seattle, Wash (E.J.M., D.B.P., C.R.I., G.E.J., G.M.S., K.V.); and Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, MA.7.220-Radiology, Seattle, WA 98105 (E.J.M., G.M.S.)
| | - Karim Valji
- From the Department of Radiology, University of Washington, Seattle, Wash (E.J.M., D.B.P., C.R.I., G.E.J., G.M.S., K.V.); and Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, MA.7.220-Radiology, Seattle, WA 98105 (E.J.M., G.M.S.)
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Mechanisms of recurrent haemoptysis after super-selective bronchial artery coil embolisation: a single-centre retrospective observational study. Eur Radiol 2018; 29:707-715. [PMID: 30054792 PMCID: PMC6302874 DOI: 10.1007/s00330-018-5637-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/24/2018] [Accepted: 06/27/2018] [Indexed: 11/21/2022]
Abstract
Objectives In recognition of the significant impairment caused by haemoptysis on a patient’s quality of life, bronchial artery embolisation has been introduced worldwide as one of the first-line treatment options. Since little evidence is available on the mechanisms of recurrent haemoptysis after super-selective bronchial artery coil embolisation (ssBACE), the purpose of the present study is to evaluate these. Methods We retrospectively evaluated the mechanisms of recurrent haemoptysis using both enhanced computed tomography and cineangiography following ssBACE by reviewing 299 haemoptysis-related arteries (HRAs) in 57 consecutive patients who underwent 2nd series ssBACE for the management of recurrent haemoptysis between April 2010 and December 2015. Results Median age of patients was 69 (interquartile range 64–74) years, and 43.9% were men. This study revealed that (1) recanalisation was the most common mechanism (45.2%) followed by development of new HRA (38.5%), bridging collaterals (14.7%) and conventional collaterals (1.7%); (2) these trends could be modified in several situations such as with antiplatelet or anticoagulant medications; (3) relatively large-diameter HRAs were more likely to recanalise compared with small-diameter HRAs and (4) recurrent haemoptysis could be managed by 2nd series ssBACE with a procedural success rate of 97.7% without any major complications. Conclusions Recanalisation was the most common mechanism of recurrent haemoptysis after ssBACE. Our results provide interventionists with indispensable insights. Key Points • Recanalisation was the most common mechanism of recurrent haemoptysis after super-selective bronchial artery coil embolisation, followed by development of new haemoptysis-related arteries • These trends could be modified in several situations such as with antiplatelet or anticoagulant medications • Recurrent haemoptysis could be managed by 2nd series super-selective bronchial artery coil embolisation with a procedural success rate of 97.7% without any major complications.
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Yun JS, Song SY, Na KJ, Kim S, Jang KH, Jeong IS, Oh SG. Surgery for hemoptysis in patients with benign lung disease. J Thorac Dis 2018; 10:3532-3538. [PMID: 30069350 DOI: 10.21037/jtd.2018.05.122] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Hemoptysis can be a life-threatening condition that requires urgent treatment. Surgery still plays an important role in managing this critical situation, although previous reports have reported high postoperative morbidity and mortality rates. We report our experience with surgical resection for hemoptysis caused by benign lung diseases. Methods We reviewed the retrospectively collected data from 94 patients undergoing pulmonary resection for various benign lung diseases with hemoptysis at a single institution from 2010 to 2016. Baseline characteristics, surgical factors, and postoperative outcomes (morbidity and mortality rates) were analyzed. Results The ratio of male to female patients was 1:1, and the mean age was 58.2±11.1 (range, 29-79) years. The etiology of hemoptysis included aspergilloma in 58 patients (61.7%), bronchiectasis in 10, tuberculosis in 7, necrotizing bronchiolitis in 6, and other inflammatory disease in 13. A total of 21 patients (22.3%) underwent emergency operation, and 73 (77.7%) had an elective operation. Pulmonary resection was performed by thoracotomy (n=53, 56.4%) and video-assisted thoracoscopic surgery (VATS) (n=41, 43.6%). Sublobar resection (n=50, 53.2%, segmentectomy in 19 and wedge resection in 31) was performed more often than lobectomy (n=35, 37.2%). Pneumonectomy was performed in 7 patients, and bilobectomy was performed in 2. Postoperative morbidity occurred in 23 patients (24.5%), with prolonged air leak being the most frequent complication (n=14, 14.9%). The in-hospital mortality rate was 3.2% (n=3). Complications were less frequent in patients undergoing an elective operation, VATS, and sublobar resection. Multivariate analysis showed that patients treated with VATS had a decreased risk of postoperative complications (odds ratio, 12.8; 95% confidence interval, 1.29-127.9; P=0.03). Conclusions Surgical resection for hemoptysis in patients with benign lung diseases is the mainstay of effective treatment with acceptable morbidity and mortality rates. If applicable, we recommend elective (planned) sublobar resection using VATS in order to improve postoperative outcomes.
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Affiliation(s)
- Ju Sik Yun
- Department of Thoracic and Cardiovascular Surgery, Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Jeollanamdo, South Korea
| | - Sang Yun Song
- Department of Thoracic and Cardiovascular Surgery, Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Jeollanamdo, South Korea
| | - Kook Joo Na
- Department of Thoracic and Cardiovascular Surgery, Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Jeollanamdo, South Korea
| | - Seok Kim
- Department of Thoracic and Cardiovascular Surgery, Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Jeollanamdo, South Korea
| | - Keun-Ho Jang
- Department of Occupational and Environmental Medicine, Mokpo Christian Hospital, Jeollanamdo, South Korea
| | - In Seok Jeong
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Gwang-ju, South Korea
| | - Sang Gi Oh
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Gwang-ju, South Korea
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Endobronchial Ultrasound-guided Transbronchial Needle Injection of Liposomal Amphotericin B for the Treatment of Symptomatic Aspergilloma. J Bronchology Interv Pulmonol 2018; 24:330-333. [PMID: 28590275 DOI: 10.1097/lbr.0000000000000383] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Surgical treatment with lung resection has traditionally been the treatment of choice for pulmonary cavities containing aspergillomas that cause hemoptysis. Endobronchial ultrasound (EBUS) is a minimally invasive bronchoscopic technique that is commonly used for transbronchial needle aspiration of hilar and mediastinal lymph nodes as well as centrally located parenchymal lesions. Here, we describe a case of a 71-year-old woman who was found to have a cavitary lesion in the lung containing aspergillomas. Under direct ultrasound visualization with EBUS, liposomal amphotericin B was injected into the aspergillomas. These aspergillomas regressed after treatment. To our knowledge, this is the first reported treatment of aspergilloma with EBUS-guided transbronchial needle injection of liposomal amphotericin B.
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Safety and Efficacy of Repeat Embolization for Recurrent Hemoptysis: A 16-Year Retrospective Study Including 223 Patients. J Vasc Interv Radiol 2018; 29:502-509. [DOI: 10.1016/j.jvir.2017.11.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 11/14/2017] [Accepted: 11/18/2017] [Indexed: 11/18/2022] Open
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30
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Kawamoto H, Suzuki M, Shiozawa A, Miyawaki E, Yamamoto S, Kobayashi K, Takasaki J, Takeda Y, Hojo M, Sugiyama H. Massive Hemoptysis with a Fungus Ball-like Shadow in an Old Tuberculosis Cavity That Was Shown to Be a Clot by Bronchoscopy. Intern Med 2018; 57:377-381. [PMID: 29093390 PMCID: PMC5827319 DOI: 10.2169/internalmedicine.8967-17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Development of aspergilloma is common in cases with a fungus ball-like shadow in cavities due to old tuberculosis. Some reports have shown that blood clots tend to appear as a fungus ball-like shadow. A 71-year-old man with a history of pulmonary tuberculosis presented with a fungus ball-like shadow in an old cavity and hemoptysis. There was no evidence of aspergillus infection on various examinations. We confirmed a blood clot and aneurysm of an artery under direct vision by bronchoscopy. A lateral thoracic artery aneurysm was detected by angiography. Transcatheter arterial embolization was performed. After treatment, the artery aneurysm disappeared.
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Affiliation(s)
- Hironori Kawamoto
- Division of Respiratory Medicine, National Center for Global Health and Medicine, Japan
- Department of Respiratory Medicine, Jikei University Hospital, Japan
| | - Manabu Suzuki
- Division of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Ayako Shiozawa
- Division of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Eriko Miyawaki
- Division of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Shota Yamamoto
- Division of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Konomi Kobayashi
- Division of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Jin Takasaki
- Division of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Yuichiro Takeda
- Division of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Masayuki Hojo
- Division of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Haruhito Sugiyama
- Division of Respiratory Medicine, National Center for Global Health and Medicine, Japan
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Bronchial artery embolization in treatment of hemoptysis: Treatment efficacy and complications at a tertiary care chest centre. Med J Armed Forces India 2017; 74:352-357. [PMID: 30449921 DOI: 10.1016/j.mjafi.2017.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 09/02/2017] [Indexed: 11/20/2022] Open
Abstract
Background Hemoptysis is one of the most alarming condition to both the patients suffering from it and the treating physicians. It is caused due to varied etiologies. One of the emergent and at times life-saving treatment option is by minimally invasive interventional radiological technique of Bronchial Atery Embolization (BAE). The authors aimed to carry out a retrospective analysis of short term efficacy and safety of all patients treated by this technique at a tertiary care thoracic centre. Methods A total of 52 patients were included in the study who had a median follow up of 35 days. All these patients were referred for hemoptysis, intractable hemoptysis not controlled by conservative management or massive hemoptysis. An analysis of the underlying etiology, immediate and short term outcomes and complications was made. Results The study showed Tuberculosis and its sequel (bronchiectasis and chronic fibrotic changes) as the commonest etiology (65%). The BAE showed high short term efficacy (92%) in stopping the hemoptysis with a relatively low complication rate especially of major complications such as spinal cord ischemia (1.9%). The study strengthens the limited Indian data available on the subject and based on its outcome, BAE should be tried in all patients presenting with uncontrollable or massive hemoptysis not getting relief by conservative management alone. Conclusion BAE is a very effective procedure with very less complications for management of massive or uncontrollable hemoptysis.
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Carteaux G, Contou D, Voiriot G, Khalil A, Carette MF, Antoine M, Parrot A, Fartoukh M. Severe Hemoptysis Associated with Bacterial Pulmonary Infection: Clinical Features, Significance of Parenchymal Necrosis, and Outcome. Lung 2017; 196:33-42. [PMID: 29026982 DOI: 10.1007/s00408-017-0064-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 10/06/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE Severe hemoptysis (SH) associated with non-tuberculosis bacterial lower respiratory tract infection (LRTI) is poorly described, and the efficacy of the usual decision-making process is unknown. This study aimed at describing the clinical, radiological patterns, mechanism, and microbiological spectrum of SH related to bacterial LRTI, and assessing whether the severity of hemoptysis and the results of usual therapeutic strategy are influenced by the presence of parenchymal necrosis. METHODS A single-center analysis of patients with SH related to bacterial LRTI from a prospective registry of consecutive patients with SH admitted to the intensive care unit of a tertiary referral center between November 1996 and May 2013. RESULTS Of 1504 patients with SH during the study period, 65 (4.3%) had SH related to bacterial LRTI, including non-necrotizing infections (n = 31), necrotizing pneumonia (n = 23), pulmonary abscess (n = 10), and excavated nodule (n = 1). The presence of parenchymal necrosis (n = 34, 52%) was associated with a more abundant bleeding (volume: 200 ml [70-300] vs. 80 ml [30-170]; p = 0.01) and a more frequent need for endovascular procedure (26/34; 76% vs. 9/31; 29%; p < 0.001). Additionally, in case of parenchymal necrosis, the pulmonary artery vasculature was involved in 16 patients (47%), and the failure rate of endovascular treatment was up to 25% despite multiple procedures. CONCLUSIONS Bacterial LRTI is a rare cause of SH. The presence of parenchymal necrosis is more likely associated with bleeding severity, pulmonary vasculature involvement, and endovascular treatment failure.
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Affiliation(s)
- Guillaume Carteaux
- Assistance Publique-Hôpitaux de Paris, Groupe Henri Mondor-Albert Chenevier, Service de Réanimation Médicale, CHU Henri Mondor, 94010, Paris, Créteil, France. .,Faculté de Médecine de Créteil, Groupe de recherche clinique CARMAS, Université Paris Est Créteil, 94010, Paris, Créteil, France.
| | - Damien Contou
- Service de reanimation polyvalente, Centre Hospitalier d'Argenteuil, 69 rue du Lieutenant-colonel Prud'hon, 95107, Paris, Argenteuil, France
| | - Guillaume Voiriot
- Faculté de Médecine de Créteil, Groupe de recherche clinique CARMAS, Université Paris Est Créteil, 94010, Paris, Créteil, France.,Assistance Publique-Hôpitaux de Paris, Unité de Réanimation médico-chirurgicale, Groupe hospitalier des Hôpitaux Universitaires de l'Est Parisien, Hôpital Tenon, 4 rue de la Chine, 75970, Paris, Cedex 20, France
| | - Antoine Khalil
- Assistance Publique-Hôpitaux de Paris, Service d'Imagerie Médicale, Groupe Hospitalier des Hôpitaux Universitaires de l'Est Parisien, Hôpital Tenon, 75970, Paris, France.,Assistance Publique-Hôpitaux de Paris, Service d'Imagerie Médicale, Hôpital Bichat-Claude-Bernard, 46, rue Henri Huchard, 75018, Paris, France.,Université Paris 07, 75205, Paris, Cedex 13, France
| | - Marie-France Carette
- Assistance Publique-Hôpitaux de Paris, Unité de Réanimation médico-chirurgicale, Groupe hospitalier des Hôpitaux Universitaires de l'Est Parisien, Hôpital Tenon, 4 rue de la Chine, 75970, Paris, Cedex 20, France.,Sorbonne Universités, UPMC Université Paris 06, Paris, France
| | - Martine Antoine
- Sorbonne Universités, UPMC Université Paris 06, Paris, France.,Assistance Publique-Hôpitaux de Paris, Service d'anatomopathologie, Groupe Hospitalier des Hôpitaux Universitaires de l'Est Parisien, Hôpital Tenon, 75970, Paris, France
| | - Antoine Parrot
- Assistance Publique-Hôpitaux de Paris, Unité de Réanimation médico-chirurgicale, Groupe hospitalier des Hôpitaux Universitaires de l'Est Parisien, Hôpital Tenon, 4 rue de la Chine, 75970, Paris, Cedex 20, France
| | - Muriel Fartoukh
- Faculté de Médecine de Créteil, Groupe de recherche clinique CARMAS, Université Paris Est Créteil, 94010, Paris, Créteil, France.,Assistance Publique-Hôpitaux de Paris, Unité de Réanimation médico-chirurgicale, Groupe hospitalier des Hôpitaux Universitaires de l'Est Parisien, Hôpital Tenon, 4 rue de la Chine, 75970, Paris, Cedex 20, France.,Sorbonne Universités, UPMC Université Paris 06, Paris, France
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Ishikawa H, Hara M, Ryuge M, Takafuji J, Youmoto M, Akira M, Nagasaka Y, Kabata D, Yamamoto K, Shintani A. Efficacy and safety of super selective bronchial artery coil embolisation for haemoptysis: a single-centre retrospective observational study. BMJ Open 2017; 7:e014805. [PMID: 28213604 PMCID: PMC5318547 DOI: 10.1136/bmjopen-2016-014805] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Evidence on the safety and long-term efficacy of super selective bronchial artery embolisation (ssBAE) using platinum coils in patients with haemoptysis is insufficient. The objective of the present study was to evaluate the safety and the 3-year postprocedure haemoptysis-free survival rate of de novo elective ssBAE using platinum coils rather than particles for the treatment of haemoptysis. DESIGN A single-centre retrospective observational study. SETTING Hemoptysis and Pulmonary Circulation Center in Japan. PARTICIPANTS A total of 489 consecutive patients with massive and non-massive haemoptysis who underwent de novo elective ssBAE without malignancy or haemodialysis. INTERVENTIONS ssBAE using platinum coils. All patients underwent CT angiography before the procedure for identifying haemoptysis-related arteries (HRAs) and for procedural planning. PRIMARY AND SECONDARY OUTCOME MEASURES The composite of the 3-year recurrence of haemoptysis and mortality from the day of the last ssBAE session. Each component of the primary end point and procedural success defined as successful embolisation of all target HRAs were also evaluated. RESULTS The median patient age was 69 years, and 46.4% were men. The total number of target vessels was 4 (quartile 2-7), and the procedural success rate was 93.4%. There were 8 (1.6%) major complications: 1 aortic dissection, 2 symptomatic cerebellar infarctions and 5 mediastinal haematoma cases. The haemoptysis-free survival rates were estimated by the Kaplan-Meier analysis at 86.9% (95% CI 83.7% to 90.2%) at 1 year, 79.4% (74.8% to 84.3%) at 2 years and 57.6% (45.1% to 73.4%) at 3 years. Although not statistically significant by the adjusted analysis of variance with multiple imputation of missing variables, cryptogenic haemoptysis tended to show the most favourable outcome and non-tuberculous mycobacterium showed the worst outcome (adjusted p=0.250). CONCLUSIONS We demonstrated the safety and long-term efficacy of elective ssBAE using platinum coils and established that it can be a valuable therapeutic option for treating patients with haemoptysis.
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Affiliation(s)
- Hideo Ishikawa
- Hemoptysis and Pulmonary-Circulation Center, Kishiwada Eishinkai Hospital, Kishiwada, Japan
| | - Masahiko Hara
- Department of Clinical Epidemiology and Biostatics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Misaki Ryuge
- Hemoptysis and Pulmonary-Circulation Center, Kishiwada Eishinkai Hospital, Kishiwada, Japan
| | - Jun Takafuji
- Hemoptysis and Pulmonary-Circulation Center, Kishiwada Eishinkai Hospital, Kishiwada, Japan
| | - Mihoko Youmoto
- Hemoptysis and Pulmonary-Circulation Center, Kishiwada Eishinkai Hospital, Kishiwada, Japan
| | - Masanori Akira
- Department of Radiology, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Yukio Nagasaka
- Rakuwakai Kyoto Pulmonary Center, Rakuwakai Otowa Hospital, Kyoto, Japan
| | - Daijiro Kabata
- Department of Clinical Epidemiology and Biostatics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kouji Yamamoto
- Department of Clinical Epidemiology and Biostatics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Ayumi Shintani
- Department of Clinical Epidemiology and Biostatics, Osaka University Graduate School of Medicine, Suita, Japan
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Pitcher HT, Harrison MA, Shaw C, Cowan SW, Hirose H, Cavarocchi N. Management considerations of massive hemoptysis while on extracorporeal membrane oxygenation. Perfusion 2016; 31:653-658. [PMID: 27229004 DOI: 10.1177/0267659116651484] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is a life-saving procedure in patients with both respiratory and cardiac failure. Bleeding complications are common since patients must be maintained on anticoagulation. Massive hemoptysis is a rare complication of ECMO; however, it may result in death if not managed thoughtfully and expeditiously. METHODS: A retrospective chart review was performed of consecutive ECMO patients from 7/2010-8/2014 to identify episodes of massive hemoptysis. The management of and the outcomes in these patients were studied. Massive hemoptysis was defined as an inability to control bleeding (>300 mL/day) from the endotracheal tube with conventional maneuvers, such as bronchoscopy with cold saline lavage, diluted epinephrine lavage and selective lung isolation. All of these episodes necessitated disconnecting the ventilator tubing and clamping the endotracheal tube, causing full airway tamponade. RESULTS: During the period of review, we identified 118 patients on ECMO and 3 (2.5%) patients had the complication of massive hemoptysis. One case was directly related to pulmonary catheter migration and the other two were spontaneous bleeding events that were propagated by antiplatelet agents. All three patients underwent bronchial artery embolization in the interventional radiology suite. Anticoagulation was held during the period of massive hemoptysis without any embolic complications. There was no recurrent bleed after appropriate intervention. All three patients were successfully separated from ECMO. CONCLUSIONS: Bleeding complications remain a major issue in patients on ECMO. Disconnection of the ventilator and clamping the endotracheal tube with full respiratory and cardiac support by V-A ECMO is safe. Early involvement of interventional radiology to embolize any potential sources of the bleed can prevent re-hemoptysis and enable continued cardiac and respiratory recovery.
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Affiliation(s)
- Harrison T Pitcher
- 1 Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Meredith A Harrison
- 1 Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Colette Shaw
- 2 Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Scott W Cowan
- 1 Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Hitoshi Hirose
- 1 Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Nicholas Cavarocchi
- 1 Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Xu W, Wang HH, Bai B. Emergency transcatheter arterial embolization for massive hemoptysis due to pulmonary tuberculosis and tuberculosis sequelae. Cell Biochem Biophys 2015; 71:179-87. [PMID: 25134662 DOI: 10.1007/s12013-014-0182-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Wei Xu
- Department of Interventional Radiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, China
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Zander T, Medina S, Montes G, Nuñez-Atahualpa L, Valdes M, Maynar M. Endoluminal occlusion devices: technology update. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2014; 7:425-36. [PMID: 25489252 PMCID: PMC4257107 DOI: 10.2147/mder.s49540] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Endoluminal occlusion has been performed since the early beginning of interventional radiology. Over recent decades, major technological advances have improved the techniques used and different devices have been developed for changing conditions. Most of these occlusion devices have been implemented in the vascular territory. Early embolization materials included glass particles, hot contrast, paraffin, fibrin, and tissue fragments such as muscle fibers and blood clots; today, occlusion materials include metallic devices, particles, and liquid materials, which can be indicated for proximal or distal occlusion, high-flow and low-flow situations, and in large-caliber and small-caliber vessels, based on need. Technological progress has led to a decreased size of delivery catheters, and an increase in safety due to release systems that permit the withdrawing and replacement of embolization material. Furthermore, bioactive embolization materials have been developed to increase the efficacy of embolization or the biological effect of medication. Finally, materials have been modified for changing indications. Intravascular stents were initially developed to keep an artery open; however, by adding a covering membrane, these stents can be used to occlude the wall of a vessel or other endoluminal structures. This article gives an overview of the devices most utilized for occlusion of endoluminal structures, as well as their major purpose in the endovascular territory.
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Affiliation(s)
- Tobias Zander
- Endoluminal/Vascular Department, Hospiten Hospital Group, Santa Cruz de Tenerife, Spain
| | - Samantha Medina
- Endoluminal/Vascular Department, Hospiten Hospital Group, Santa Cruz de Tenerife, Spain
| | - Guillermo Montes
- Endoluminal/Vascular Department, Hospiten Hospital Group, Santa Cruz de Tenerife, Spain
| | | | - Michel Valdes
- Endoluminal/Vascular Department, Hospiten Hospital Group, Santa Cruz de Tenerife, Spain
| | - Manuel Maynar
- Endoluminal/Vascular Department, Hospiten Hospital Group, Santa Cruz de Tenerife, Spain ; University of Las Palmas de Gran Canarias, Las Palmas, Canary Island, Spain
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Immediate and long-term results of bronchial artery embolization for hemoptysis due to benign versus malignant pulmonary diseases. Am J Med Sci 2014; 348:204-9. [PMID: 24556929 DOI: 10.1097/maj.0000000000000226] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Bronchial artery embolization (BAE) is widely used for the treatment of hemoptysis. The immediate and long-term results of BAE for hemoptysis in patients with benign and malignant pulmonary diseases were inconsistent in previous studies and were thus investigated. METHODS This was a retrospective review of the clinical records of 154 patients (108 with benign disease and 46 with malignant disease) who received BAE for hemoptysis from January 2005 to June 2011 at the Chinese People's Liberation Army General Hospital. RESULTS Immediate cessation of hemoptysis was achieved in 98 patients with benign disease (90.7%) and 42 patients with malignancy (91.3%). The long-term control rate of hemoptysis in patients with benign disease was 74.3% (80/108) at 1 year, significantly higher than in patients with cancer (16/46, 35.5%, P < 0.01). The worst outcomes in the benign and malignant groups were observed in patients with aspergilloma and squamous cell lung cancer, respectively. The average number of abnormal vessels on bronchial arteriography was higher in the benign group than in the malignant group (3 ± 1.3 versus 2 ± 1.1, respectively, P < 0.01). Moreover, recurrent hemoptysis was independently associated with the presence of massive hemoptysis and bronchial-pulmonary artery shunt in both groups (P < 0.05). CONCLUSIONS BAE is a relatively safe procedure for patients with hemoptysis. Immediate control of hemoptysis with BAE is achieved in most cases, but the long-term hemoptysis control rate is worse in malignant lung diseases than in benign conditions, especially among patients with squamous cell lung cancer.
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Tresoldi S, Di Leo G, Villa F, Squarza SAC, Beneggi IM, Flor N, Sardanelli F, Cornalba G. Bronchial artery hypertrophy is correlated with coronary artery disease. Acta Radiol 2014; 55:287-94. [PMID: 23928008 DOI: 10.1177/0284185113496678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Bronchial arteries support the systemic pulmonary vasculature and physiologically communicate with pulmonary arteries and coronary arteries. While there is evidence supporting the link between pulmonary diseases and bronchial artery hypertrophy (BAH), few data on the correlation between coronary artery disease (CAD) and BAH have been published. PURPOSE To evaluate a possible association between BAH and CAD in patients without known pulmonary diseases undergoing computed tomography coronary angiography (CTCA). MATERIAL AND METHODS This retrospective study was approved by the local ethics committee. One hundred patients with varying degrees of CAD underwent CTCA. Patients were stratified into four groups as follows: group I, 25 patients without CAD or with non-significant CAD; group II, 25 untreated patients with significant CAD; group III, 25 stented patients; group IV, 25 patients with coronary artery bypass grafts. The number and diameter of bronchial arteries were recorded. Correlation between age, CAD, and BAH was estimated. RESULTS One hundred and ninety-nine bronchial arteries were detected. Approximately 51% were hypertrophic (diameter, >1.5 mm) with a mean diameter of 1.7 ± 0.5 mm. Seventy-six patients showed no pulmonary alterations; 24 were found to have previously undiagnosed pulmonary findings, six of which were severe. Presence and degree of CAD correlated with patients' mean age (60 in group I, 68 in group II, 65 in group III, 69 in group IV; P = 0.023), and mean bronchial artery transverse diameter (1.6 mm, 1.7 mm, 1.8 mm, and 2.0 mm, respectively; P = 0.009). The bronchial artery diameter was not associated with pulmonary findings (P = 0.390). CONCLUSION There is an association between CAD and BAH. In patients with no pulmonary alterations, BAH could be caused by undiagnosed underlying CAD.
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Affiliation(s)
- Silvia Tresoldi
- Servizio di Radiologia Diagnostica ed Interventistica, Azienda Ospedaliera San Paolo, Milan, Italy
| | - Giovanni Di Leo
- Unità di Radiologia, IRCCS Policlinico San Donato, Milan, Italy
| | - Federica Villa
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milan, Italy
| | | | - Irene Maria Beneggi
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milan, Italy
| | - Nicola Flor
- Servizio di Radiologia Diagnostica ed Interventistica, Azienda Ospedaliera San Paolo, Milan, Italy
| | - Francesco Sardanelli
- Unità di Radiologia, IRCCS Policlinico San Donato, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | - Gianpaolo Cornalba
- Servizio di Radiologia Diagnostica ed Interventistica, Azienda Ospedaliera San Paolo, Milan, Italy
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
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Lee MK, Kim SH, Yong SJ, Shin KC, Kim HS, Yu TS, Choi EH, Lee WY. Moderate hemoptysis: recurrent hemoptysis and mortality according to bronchial artery embolization. CLINICAL RESPIRATORY JOURNAL 2014; 9:53-64. [PMID: 24406077 DOI: 10.1111/crj.12104] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 11/24/2013] [Accepted: 01/04/2014] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The studies on hemoptysis have focused mainly on hemoptysis causes and massive or life-threatening hemoptysis. And there is a limited data that non-massive hemoptysis, especially moderate hemoptysis. OBJECTIVES We analyzed the prognosis and severity of bleeding on flexible bronchoscopy (FB) between moderate and massive hemoptysis. METHODS We reviewed total 852 subjects (59.9 ± 16.0 years) identified with hemoptysis. Reviewed database included severity of subjective hemoptysis, bleeding on FB, comorbid conditions, time from admission to bronchial artery embolization (BAE), recurrent hemoptysis and mortality. RESULTS In subjective hemoptysis, recurrent hemoptysis occurred in mild 8.0%, moderate 40.7%, massive hemoptysis 33.8%, and mortality was 4.7%, 13.4% and 13.5%. Especially, no statistical difference was shown in recurrent hemoptysis [hazard ratio (HR) = 0.795; 95% confidence interval (CI) 0.562-1.125, P = 0.196] and mortality (HR = 1.054; 95% CI 0.596-1.864, P = 0.856) between moderate and massive hemoptysis. In moderate hemoptysis patients, oozing or active bleeding on FB took up 83.3%. In this review, recurrent hemoptysis was more in oozing bleeding than active bleeding (HR = 1.781; 95% CI 1.214-2.431, P = 0.002), but mortality was similar (HR = 1.611; 95% CI 0.930-2.790, P = 0.089). Recurrent hemoptysis significantly decreased in the group with BAE performed within 24 h (HR = 0.308; 95% CI 0.149-0.637, P = 0.001) in moderate hemoptysis. Also, recurrent hemoptysis and mortality were significantly increased in the patients with smoking (≥40 pack-years), oozing or active bleeding on FB, and hypertension. CONCLUSION Moderate hemoptysis has shown similar prognosis of recurrent hemoptysis and mortality to massive hemoptysis. Therefore, the more aggressive FB and BAE should be considered in moderate hemoptysis.
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Affiliation(s)
- Myoung Kyu Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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Garcia-Olivé I, Sanz-Santos J, Centeno C, Andreo F, Muñoz-Ferrer A, Serra P, Sampere J, Michavila JM, Muchart J, Manzano JR. Results of Bronchial Artery Embolization for the Treatment of Hemoptysis Caused by Neoplasm. J Vasc Interv Radiol 2014; 25:221-8. [DOI: 10.1016/j.jvir.2013.09.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 09/26/2013] [Accepted: 09/27/2013] [Indexed: 10/26/2022] Open
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Predictors of Recanalization in Patients With Life-Threatening Hemoptysis Requiring Artery Embolization. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.arbr.2014.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Rashad A, Amin M, El-Azim AA, Zidan M, Mahmoud A. Percutaneous transcatheter vascular embolization for life threatening hemoptysis. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2013. [DOI: 10.1016/j.ejcdt.2013.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Predictors of recanalization in patients with life-threatening hemoptysis requiring artery embolization. Arch Bronconeumol 2013; 50:51-6. [PMID: 23932187 DOI: 10.1016/j.arbres.2013.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Revised: 06/05/2013] [Accepted: 06/06/2013] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Artery embolization (AE) is a safe and useful procedure in the management of massive hemoptysis. The objective of our study was to describe the experience of AE in a tertiary referral center, to characterize angiographic findings at the time of recurrence, and to analyze factors associated with these findings. MATERIAL AND METHODS Observational retrospective study of patients presenting with life-threatening hemoptysis. All consecutive patients with at least one episode of hemoptysis that required AE during a 13-year period were included. The effects of i)time to recurrence; ii)use of coils, and iii)number of arteries embolized on the likelihood that the recurrence was secondary to recanalization were assessed. RESULTS One hundred seventy-six patients were included in the study. Twenty-two patients (12.5%) died due to hemoptysis. Probability of recurrence-free survival at one month was 0.91 (95%CI: 0.87 to 0.95), at 12months was 0.85 (95%CI: 0.79 to 0.91), and after 3 years was 0.75 (95%CI: 0.66 to 0.83). A longer time to recurrence was associated with a higher probability that the hemorrhage affected the same artery (estimate=0.0157, z-value=2.41, p-value=0.016). CONCLUSION AE is a safe and useful technique in the management of massive and recurrent hemoptysis. Nevertheless, recurrence after embolization is not uncommon. Recurring hemoptysis due to recanalization is related to time to recurrence, but not to the use of coils or number of arteries embolized.
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Affiliation(s)
- Dawn E Jaroszewski
- Division of Cardiothoracic Surgery, Department of Surgery, Mayo Clinic, Arizona, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA.
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Hwang HG, Lee HS, Choi JS, Seo KH, Kim YH, Na JO. Risk factors influencing rebleeding after bronchial artery embolization on the management of hemoptysis associated with pulmonary tuberculosis. Tuberc Respir Dis (Seoul) 2013; 74:111-9. [PMID: 23579345 PMCID: PMC3617130 DOI: 10.4046/trd.2013.74.3.111] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 11/27/2012] [Accepted: 02/26/2013] [Indexed: 11/24/2022] Open
Abstract
Background Hemoptysis 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. Methods We retrospectively evaluated risk factors and the time for rebleeding after BAE in 72 patients presenting with hemoptysis. Results The 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. Conclusion BAE 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.
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Affiliation(s)
- Hun-Gyu Hwang
- Respiratory Devision, Department of Internal Medicine, Soonchunhyang University Gumi Hospital, Soonchunhyang University College of Medicine, Gumi, Korea
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Racil H, Rajhi H, Ben Naceur R, Chabbou A, Bouecha H, Mnif N. Endovascular treatment of haemoptysis: medium and long-term assessment. Diagn Interv Imaging 2012; 94:38-44. [PMID: 23246187 DOI: 10.1016/j.diii.2012.05.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To assess the short, medium and long-term results of bronchial artery embolisation (BAE) and identify the factors favouring the recurrence of haemoptysis. PATIENTS AND METHODS This is a retrospective study, between January 2001 and June 2010, comprising 53 consecutive patients with BAE. The mean age was 53.8 years. There were 15 women (28.30%) and 38 men (71.69%). RESULTS The aetiologies of haemoptysis were dominated by the residual signs of pulmonary tuberculosis: 18 cases (33.96%), bronchial dilations: 12 cases (22.64%) and aspergilloma: five cases (9.43%). The bronchial arteriography showed signs of bronchial hypervascularisation in 92.45% of the cases. Forty-six patients had a first embolisation (86.79%) with immediate efficacy in 84.90% of the cases (n=45). This efficacy was noted after more than 3 years in 60.08% of the cases. Short (< 30 days) and medium-term (> 30 days and < 3 years) recurrence of haemoptysis were noted in 17.39% and 8.69% of the cases respectively. A statistically significant correlation between aspergilloma and the immediate recurrence was found (P=0.013). The risk of medium and long-term recurrence (> 3 years) was correlated with age. The survival without recurrence was statistically higher when the age was less than 60 years (P=0.0041). CONCLUSION BAE is an effective treatment. Aspergilloma is a major risk factor in the recurrence of haemoptysis. Repeated embolisation may be proposed for these patients.
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Affiliation(s)
- H Racil
- Service de pneumologie (Pavillon II), faculté de médecine EL Manar, hôpital Abderrahmen Mami, Ariana, 2080 Ariana, Tunisia.
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Abstract
Bronchial artery angiography with embolization has become a mainstay in the treatment of hemoptysis. Major complications are rare and immediate clinical success defined as cessation of hemorrhage ranges in most series from 85% to 100%, although recurrence of hemorrhage ranges from 10% to 33%. Bronchial artery embolization offers a minimally invasive procedure for even the most compromised patient serving as first-line treatment for hemorrhage as well as providing a bridge to more definitive medical or surgical intervention focused upon the etiology of the hemorrhage. The aim of this article is to summarize the etiologies, pathophysiology, and the diagnostic and management strategies of hemoptysis as related to bronchial artery embolization. In addition, the techniques of arteriography and embolization as well as associated procedural outcomes and complications are delineated.
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Affiliation(s)
- David R Sopko
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
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Laborda A, Tejero C, Fredes A, Cebrian L, Guelbenzu S, de Gregorio MA. Posterior circulation stroke after bronchial artery embolization. A rare but serious complication. Cardiovasc Intervent Radiol 2012; 36:860-3. [PMID: 22869045 DOI: 10.1007/s00270-012-0457-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 07/12/2012] [Indexed: 11/24/2022]
Abstract
Bronchial artery embolization (BAE) is the treatment of choice for massive hemoptysis with rare complications that generally are mild and transient. There are few references in the medical literature with acute cerebral embolization as a complication of BAE. We report a case of intracranial posterior territory infarctions as a complication BAE in a patient with hemoptysis due to bronchiectasis.
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Renaud S, Falcoz PE, Santelmo N, Massard G. [Management of massive hemoptysis]. REVUE DE PNEUMOLOGIE CLINIQUE 2012; 68:123-130. [PMID: 22386325 DOI: 10.1016/j.pneumo.2012.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/19/2011] [Indexed: 05/31/2023]
Abstract
Massive hemoptyses are serious clinical conditions that can quickly jeopardize the vital prognosis. The major risk is asphyxiation, due to the bleeding into the tracheobronchial tree. The clinician should provide in parallel support for diagnosis and treatment, locating the bleeding but also finding its cause. Such patients should be cared for by a multidisciplinary team, having quick access to an important technical support. The association fiberoptic bronchoscopy-chest CT scan seems to be the most effective to locate and identify the cause of the bleeding. The development of bronchial artery embolization has revolutionized the management of these patients, replacing surgery in many of its indications. The latter still keeps a place in the management of these patients. Indeed, it is the main etiological treatment, preventing the vast majority of recidivism. It is absolutely indicated in the treatment of bleeding from the pulmonary vessels, and in case of failure of other techniques. It should be performed whenever possible away from the episode of hemoptysis, in order to minimize the operative risk.
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Affiliation(s)
- S Renaud
- Service de chirurgie thoracique, nouvel hôpital civil, 1 place de l'Hôpital, Strasbourg, France
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50
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Yonker LM, Mark EJ, Canapari CA. Aspergilloma in a patient with an occult congenital pulmonary airway malformation. Pediatr Pulmonol 2012; 47:308-10. [PMID: 21905264 DOI: 10.1002/ppul.21538] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 06/10/2011] [Indexed: 11/06/2022]
Abstract
We describe the case of a 14-year-old male who presented with a right upper lobe aspergilloma forming in a previously occult congenital pulmonary airway malformation. This is the first case describing an aspergilloma forming within a CPAM.
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Affiliation(s)
- Lael M Yonker
- Harvard Medical School, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts, USA.
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