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Takigawa Y, Sato K, Kudo K, Inoue T, Fujiwara M, Matsuoka S, Watanabe H, Sato A, Mukai T, Fujiwara K. Safety and efficacy of airway stent placement following bronchial artery embolization: A retrospective study at a single institute. Respir Investig 2024; 62:640-644. [PMID: 38749078 DOI: 10.1016/j.resinv.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 05/01/2024] [Accepted: 05/09/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Airway stenting is an established procedure for treating oncological emergencies in patients with airway disorders. In patients with airway hemorrhage, respiratory conditions may worsen during stenting. Bronchial artery embolization (BAE) is useful to prevent bleeding from the bronchus. We aimed to evaluate the efficacy and safety of airway stenting after BAE in patients with malignant airway disorders. METHODS The medical records of all patients who underwent airway stenting following BAE at the National Hospital Organization Okayama Medical Center between 2016 and 2023 were retrospectively reviewed. RESULTS Thirteen procedures (11 silicone Y stents, one hybrid stent, and one self-expandable metallic stent) were performed. The median duration from BAE to airway stenting was one day (range: 1-5 days). Nine patients experienced tumor shrinkage, and none experienced severe bleeding after BAE during the stent procedure. No other major complications were associated with the stent placement. The median survival time after stenting was 169 days (range; 24-1086). No serious complications caused by BAE, such as spinal cord infarction, were observed. CONCLUSIONS Airway stent placement was safely performed after BAE without severe bleeding or acute respiratory failure. BAE, followed by airway stenting, is useful.
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Affiliation(s)
- Yuki Takigawa
- Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, 1711-1 Tamasu Kita-ku, Okayama, 701-1192, Japan.
| | - Ken Sato
- Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, 1711-1 Tamasu Kita-ku, Okayama, 701-1192, Japan
| | - Kenichiro Kudo
- Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, 1711-1 Tamasu Kita-ku, Okayama, 701-1192, Japan
| | - Tomoyoshi Inoue
- Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, 1711-1 Tamasu Kita-ku, Okayama, 701-1192, Japan
| | - Miho Fujiwara
- Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, 1711-1 Tamasu Kita-ku, Okayama, 701-1192, Japan
| | - Suzuka Matsuoka
- Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, 1711-1 Tamasu Kita-ku, Okayama, 701-1192, Japan
| | - Hiromi Watanabe
- Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, 1711-1 Tamasu Kita-ku, Okayama, 701-1192, Japan
| | - Akiko Sato
- Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, 1711-1 Tamasu Kita-ku, Okayama, 701-1192, Japan
| | - Takashi Mukai
- Department of Radiology, National Hospital Organization Okayama Medical Center, 1711-1 Tamasu Kita-ku, Okayama, 701-1192, Japan
| | - Keiichi Fujiwara
- Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, 1711-1 Tamasu Kita-ku, Okayama, 701-1192, Japan
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Tashiro M, Takazono T, Izumikawa K. Chronic pulmonary aspergillosis: comprehensive insights into epidemiology, treatment, and unresolved challenges. Ther Adv Infect Dis 2024; 11:20499361241253751. [PMID: 38899061 PMCID: PMC11186400 DOI: 10.1177/20499361241253751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 04/23/2024] [Indexed: 06/21/2024] Open
Abstract
Chronic pulmonary aspergillosis (CPA) is a challenging respiratory infection caused by the environmental fungus Aspergillus. CPA has a poor prognosis, with reported 1-year mortality rates ranging from 7% to 32% and 5-year mortality rates ranging from 38% to 52%. A comprehensive understanding of the pathogen, pathophysiology, risk factors, diagnosis, surgery, hemoptysis treatment, pharmacological therapy, and prognosis is essential to manage CPA effectively. In particular, Aspergillus drug resistance and cryptic species pose significant challenges. CPA lacks tissue invasion and has specific features such as aspergilloma. The most critical risk factor for the development of CPA is pulmonary cavitation. Diagnostic approaches vary by CPA subtype, with computed tomography (CT) imaging and Aspergillus IgG antibodies being key. Treatment strategies include surgery, hemoptysis management, and antifungal therapy. Surgery is the curative option. However, reported postoperative mortality rates range from 0% to 5% and complications range from 11% to 63%. Simple aspergilloma generally has a low postoperative mortality rate, making surgery the first choice. Hemoptysis, observed in 50% of CPA patients, is a significant symptom and can be life-threatening. Bronchial artery embolization achieves hemostasis in 64% to 100% of cases, but 50% experience recurrent hemoptysis. The efficacy of antifungal therapy for CPA varies, with itraconazole reported to be 43-76%, voriconazole 32-80%, posaconazole 44-61%, isavuconazole 82.7%, echinocandins 42-77%, and liposomal amphotericin B 52-73%. Combinatorial treatments such as bronchoscopic triazole administration, inhalation, or direct injection of amphotericin B at the site of infection also show efficacy. A treatment duration of more than 6 months is recommended, with better efficacy reported for periods of more than 1 year. In anticipation of improvements in CPA management, ongoing advances in basic and clinical research are expected to contribute to the future of CPA management.
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Affiliation(s)
- Masato Tashiro
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
- Infection Control and Education Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Takahiro Takazono
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Koichi Izumikawa
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Infection Control and Education Center, Nagasaki University Hospital, Nagasaki, Japan
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Wang DX, Wang YG, Ding GX, Li B, Liu RN, Ai ZW, Wang Y. The effectiveness of the puncture channel plugging for reduction of complications after CT-guided percutaneous transthoracic needle biopsy. Sci Rep 2023; 13:12318. [PMID: 37516777 PMCID: PMC10387056 DOI: 10.1038/s41598-023-38915-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 07/17/2023] [Indexed: 07/31/2023] Open
Abstract
The effect of plugging the puncture channel with a mixture of hemocoagulase injection on the complications of CT-guided percutaneous transthoracic need biopsy (PTNB) was discussed. The medical records of PTNB were retrospectively studied from June 2017 to May 2022. In the study, the puncture channel of 626 patients were blocked, while remain 681 patients' were not. The Mantel Haenszel method performed layered analysis and evaluated the correlation of adjusted confounding factors. The Odds Ratio and its 95% confidence interval were calculated using the Woof method. The incidence of high-level pulmonary hemorrhage was significantly reduced in patients with lesions ≤ 2 cm and different needle lengths. Patients with different pleural-needle tip angle and perineedle emphysema were blocked, and the incidence of pneumothorax and thoracic implants was significantly reduced. Through puncture channel plugging, the incidence of pulmonary hemorrhage, pneumothorax and thoracic catheterization of PTNB under CT guidance was reduced.
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Affiliation(s)
- Dong-Xu Wang
- Medical Imaging Center, the Second Affiliated Hospital of Qiqihar Medical University, Qiqihar, 161006, Heilongjiang, China.
| | - Yu-Guang Wang
- Medical Imaging Center, the Second Affiliated Hospital of Qiqihar Medical University, Qiqihar, 161006, Heilongjiang, China
| | - Guo-Xu Ding
- Medical Imaging Center, the Second Affiliated Hospital of Qiqihar Medical University, Qiqihar, 161006, Heilongjiang, China
| | - Bo Li
- Medical Imaging Center, the Second Affiliated Hospital of Qiqihar Medical University, Qiqihar, 161006, Heilongjiang, China
| | - Rui-Nan Liu
- Medical Imaging Center, the Second Affiliated Hospital of Qiqihar Medical University, Qiqihar, 161006, Heilongjiang, China
| | - Zhong-Wei Ai
- Department of Pathology, Qiqihar Medical University, Qiqihar, 161006, Heilongjiang, China
| | - Yang Wang
- Medical Imaging Center, the Second Affiliated Hospital of Qiqihar Medical University, Qiqihar, 161006, Heilongjiang, China
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Abstract
Massive hemoptysis is a highly morbid medical condition with up to 75% mortality with conservative treatment. Bronchial artery embolization has emerged as the common treatment for both acute massive hemoptysis and chronic hemoptysis. This article will review the clinical presentation, bronchial artery anatomy, embolization procedure, complications, and expected outcomes.
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Affiliation(s)
- Claire S. Kaufman
- Dotter Department of Interventional Radiology, Oregon Health & Sciences University, Portland, Oregon
| | - Sharon W. Kwan
- Dotter Department of Interventional Radiology, Oregon Health & Sciences University, Portland, Oregon
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Bronchial artery embolization for hemoptysis: A systematic review and meta-analysis. J Interv Med 2021; 4:172-180. [PMID: 35586385 PMCID: PMC8947981 DOI: 10.1016/j.jimed.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/04/2021] [Accepted: 08/10/2021] [Indexed: 11/20/2022] Open
Abstract
Objective To assess the safety and efficacy of bronchial artery embolization (BAE) for hemoptysis. Methods and materials Databases with articles published in English, including Pubmed, Embase, Web of science and Chochrane library, were comprehensively searched to get accurate, up-to-date and sufficient literature about BAE for hemoptysis until March 2020. The technical success rates, immediate control rates, recurrence rates, mortality rates, and total complication rates (minor and major complication rates) extracted from the articles were pooled to estimate and assess the efficacy and safety of BAE using random-effect and fixed-effect models. Results 21 articles published between 2008 and 2019, which include a total of 2511 patients, were studied to evaluate the safety and efficacy of BAE. The technical success and immediate control rates are 99.9% (95%CI: 99%–100%) and 99.5% (95%CI: 97.8%–99.2%), respectively. This study showed hemoptysis recurrence in 23.7% (95%CI: 18.5%–28.9%) with a mortality rate of 2% (95%CI: 0–3%). Additionally, the assessment of complications revealed a total complication rate of 13.4% (95% CI: 7.6–19.2%), in which 0.2% (95% CI: 0.2–0.4%) were major complications and 10% (95% CI: 4.7–9.6%) were minor complications. Conclusion BAE is an effective, safe, and feasible procedure with a low complication rate for hemoptysis patients. However, recurrence of hemoptysis is still at high risk after BAE due to different underlying diseases.
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Ishikawa H, Ohbe H, Omachi N, Morita K, Yasunaga H. Spinal Cord Infarction after Bronchial Artery Embolization for Hemoptysis: A Nationwide Observational Study in Japan. Radiology 2021; 298:673-679. [PMID: 33464182 DOI: 10.1148/radiol.2021202500] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background The most serious complication of bronchial artery embolization (BAE) for hemoptysis is spinal cord infarction. However, because it is rare, previous reports from single institutions have been insufficient to determine the actual prevalence of spinal cord infarction after BAE. Purpose To investigate the actual prevalence of spinal cord infarction as a complication of BAE using a nationally representative inpatient database. Materials and Methods This retrospective study was performed using data from the Japanese Diagnosis Procedure Combination database between July 2010 and March 2018. The authors identified patients who were diagnosed with hemoptysis and underwent BAE during hospitalization. The overall prevalence of spinal cord infarction after BAE was determined. The authors also compared the prevalence of spinal cord infarction using the Fisher exact test according to the embolic agent used for BAE: coils, gelatin sponge (GS) particles, and N-butyl-2-cyanoacrylate (NBCA). Results During the study period, 8563 patients (mean age ± standard deviation, 68 years ± 13; 5103 men) met the inclusion criteria. Among these 8563 patients, 1577 (18%), 6561 (77%), and 425 (5%) underwent BAE with coils, GS particles, and NBCA, respectively. The overall prevalence of spinal cord infarction as a complication of BAE was 0.19% (16 of 8563 patients). The prevalence of spinal cord infarction after BAE with coils, GS particles, and NBCA was 0.06% (one of 1577 patients), 0.18% (12 of 6561 patients), and 0.71% (three of 425 patients), respectively (P = .04). Conclusion With use of a nationwide real-world inpatient database, the results of this study demonstrated that the actual prevalence of spinal cord infarction as a complication of bronchial artery embolization (BAE) for hemoptysis was 0.19%. Patients who underwent BAE with coils had a lower prevalence of spinal cord infarction than patients who underwent BAE with gelatin sponge particles or N-butyl-2-cyanoacrylate. © RSNA, 2021.
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Affiliation(s)
- Hideo Ishikawa
- From the Hemoptysis and Pulmonary-Circulation Center, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Japan (H.I., N.O.); Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan (H.O., H.Y.); and Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan (K.M.)
| | - Hiroyuki Ohbe
- From the Hemoptysis and Pulmonary-Circulation Center, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Japan (H.I., N.O.); Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan (H.O., H.Y.); and Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan (K.M.)
| | - Naoki Omachi
- From the Hemoptysis and Pulmonary-Circulation Center, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Japan (H.I., N.O.); Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan (H.O., H.Y.); and Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan (K.M.)
| | - Kojiro Morita
- From the Hemoptysis and Pulmonary-Circulation Center, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Japan (H.I., N.O.); Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan (H.O., H.Y.); and Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan (K.M.)
| | - Hideo Yasunaga
- From the Hemoptysis and Pulmonary-Circulation Center, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Japan (H.I., N.O.); Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan (H.O., H.Y.); and Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan (K.M.)
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Giang NT, Dung LT, Hien NT, Thiet TT, Hiep PS, Pho DC, Hung PN. Plombage for Hemoptysis Control in Pulmonary Aspergilloma: Safety and Effectiveness of Forgettable Surgery in High-Risk Patients. Ann Thorac Cardiovasc Surg 2021; 27:10-17. [PMID: 33408306 PMCID: PMC8043030 DOI: 10.5761/atcs.oa.20-00169] [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] [Indexed: 11/18/2022] Open
Abstract
Objectives: To evaluate plombage surgery for hemoptysis control in pulmonary aspergilloma in high-risk patients. Methods: This study was carried out on 75 pulmonary aspergilloma patients presenting with hemoptysis that underwent a plombage surgery for approximately 7 years (November 2011–September 2018) at Pham Ngoc Thach Hospital. They revisited the hospital 6 months after plombage surgery and considered plombage removal. The group whose plombage was removed was compared with that whose plombage was retained 6 and 24 months after surgery. Results: Hemoptysis reduced significantly after surgery. Hemoptysis ceased in 91.67% of the patients and diminished in 8.33% of the patients 6 months after surgery. Similarly, hemoptysis ceased in 87.32% of the patients and diminished in 12.68% of the patients 24 months after surgery. Body mass index (BMI) index, Karnofsky score, and forced expiratory volume in one second (FEV1) increased. Plombage surgery was performed with operative time of 129.5 ± 36.6 min, blood loss during operation of 250.7 ± 163.1 mL, and the number of table tennis balls of 4.22 ± 2.02. No deaths related to plombage surgery were recorded. Plombage was removed in 29 cases because of patients’ requirements (89.8%), infection (6.8%), and pain (3.4%). There were no patient developing complications after the treatment and there were no statistically significant differences between the two groups. Conclusions: Plombage surgery is safe and effective for hemoptysis control in pulmonary aspergilloma. To minimize the risk of long-term complications, surgeons should remove the plombage 6 months after the initial operation.
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Affiliation(s)
- Nguyen Truong Giang
- Department of Cardiothoracic Surgery, Military Hospital, Vietnam Military Medical University, Ha Noi, Vietnam
| | - Le Tien Dung
- Department of Thoracic Surgery, Pham Ngoc Thach Hospital, Ho Chi Minh, Vietnam
| | - Nguyen Thanh Hien
- Department of Thoracic Surgery, Pham Ngoc Thach Hospital, Ho Chi Minh, Vietnam
| | - Truong Thanh Thiet
- Department of Thoracic Surgery, Pham Ngoc Thach Hospital, Ho Chi Minh, Vietnam
| | - Phan Sy Hiep
- Department of Thoracic Surgery, Pham Ngoc Thach Hospital, Ho Chi Minh, Vietnam
| | - Dinh Cong Pho
- Department of Infection Control, Military Hospital, Vietnam Military Medical University, Ha Noi, Vietnam
| | - Pham Ngoc Hung
- Department of Epidemiology, Vietnam Military Medical University, Ha Noi, Vietnam.,Department of Training, Vietnam Military Medical University, Ha Noi, Vietnam
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Recurrent Hemoptysis After Bronchial Artery Embolization: Prediction Using a Nomogram and Artificial Neural Network Model. AJR Am J Roentgenol 2020; 215:1490-1498. [PMID: 33052741 DOI: 10.2214/ajr.20.22775] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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