Bronchial Artery Embolization in Life-Threatening Hemoptysis: Outcome and Predictive Factors

The efficacy and safety of combined therapy with endobronchial tamponade and bronchial artery embolization for massive hemoptysis

BACKGROUND

Massive hemoptysis is characterized by its life-threatening nature, potentially leading to airway obstruction and asphyxia. The objective of this study was to evaluate the clinical effectiveness of combining endobronchial tamponade with bronchial artery embolization (BAE) in the treatment of massive hemoptysis.

METHODS

Between March 2018 and March 2022, a total of 67 patients with massive hemoptysis who underwent BAE were divided into two groups: the combination group (n = 26) and the BAE group (n = 41). Technical and clinical success rates were assessed, and adverse events were monitored following the treatment. Blood gas analysis and coagulation function indicators were collected before and after the treatment, and recurrence and survival rates were recorded during the follow-up period.

RESULTS

All patients achieved technical success. There were no significant differences in the clinical success rate, recurrence rates at 3 and 6 months, and mortality rates at 3 months, 6 months, and 1 year between the combination group and the BAE group. However, the hemoptysis recurrence rate at 1 year was significantly lower in the combination group compared to the BAE group (15.4% vs. 39.0%, P = 0.039). No serious adverse events were reported in either group. After treatment, the combination group showed higher levels of arterial partial pressure of oxygen (PaO2), oxygenation index (PaO2/FiO2), fibrinogen (FIB), and D-dimer (D-D) compared to the BAE group (P < 0.05). Multivariate regression analysis demonstrated a significant correlation between combined therapy and hemoptysis-free survival.

CONCLUSION

Combination therapy, compared to embolization alone, exhibits superior efficacy in improving respiratory function, correcting hypoxia, stopping bleeding, and preventing recurrence. It is considered an effective and safe treatment for massive hemoptysis.

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

BACKGROUND

Bronchial artery embolization (BAE) using particles is an established treatment for hemoptysis. The use of polyvinyl alcohol (PVA) with a particle size of 300 µm or larger is thought to reduce the risk of non-target embolization but may result in more proximal vessel occlusion than is ideal, resulting in a high rate of early recurrent hemorrhage.

OBJECTIVE

This study evaluates the safety and efficacy of BAE using PVA particles with a size of less than 300 µm.

METHODS

All patients who underwent BAE between 2010 and 2022 at a tertiary center were included. Demographic data, etiology and volume of hemoptysis, technical and clinical success, procedure-related complications, and follow-up information were collected from patients' electronic records. 150-250 µm PVA particles were used to commence embolization in all patients with the subsequent use of larger-sized particles in some individuals. The Kaplan-Meier method was used to estimate recurrence and survival rates.

RESULTS

One hundred forty-four patients underwent 189 embolization procedures between 2010 and 2022 and were followed up for a median of 35 months [IQR 19-89]. 150 µm to 250 µm PVA particles were used as the sole embolic agent in 137 cases. Hemoptysis recurred within 30 days in 7%. The median time to repeat intervention was 144 days [IQR 42-441]. Seventeen out of 144 patients had a pulmonary artery branch pseudoaneurysm. The rate of major complications was 1% with no instances of stroke or spinal artery ischemia. Thirty-day mortality was 2% (4/189).

CONCLUSION

BAE using 150-250 µm PVA particles is safe and effective with few complications and low rates of early hemoptysis recurrence.

CLINICAL RELEVANCE STATEMENT

BAE using small particles is likely to improve outcomes, particularly the rate of early recurrence, in patients with hemoptysis, without an increase in procedural complications.

KEY POINTS

BAE is a safe and effective treatment for patients with hemoptysis. Using small PVA particles in BAE has few complications and low rates of early recurrence. Pulmonary artery pseudoaneurysms should be actively sought in those with hemoptysis undergoing BAE.

Acute Hemoptysis Caused by Eroding Spinal Fusion Hardware Into the Left Lower Lobe of the Lung

Hemoptysis can occur in rare cases as a late complication of anterior approach spinal rod surgery in the spine. Our patient presented with hemoptysis. At age 14, he underwent an anterior approach spine surgery for scoliosis. He underwent bronchoscopy, and a round serrated metal object was visible in the left lower lobe. Multiple attempts were unsuccessful in retrieving the metal object. A review of the imaging did not show obvious penetration of the spinal instrumentation into the lung; however, the metallic object was believed to be a round serrated metal object from the fusion spinal hardware. Due to low lung function and the risk of injuring the surrounding tissue, the patient was not deemed a candidate for lobectomy or removal of the hardware. Instead, the patient underwent a left bronchial arterial embolization (BAE) procedure, which successfully stopped the hemoptysis.

Bronchial Artery Embolization in Management of Hemoptysis in a Developing Country: An Initial Experience

Purpose This article evaluates the immediate success, recurrence rate, complications, and the culprit vessel of bronchial artery embolization (BAE) in patients presenting with hemoptysis.

Methods and Materials All patients who underwent BAE from July 1, 2018 to August 31, 2021 were included. BAE was done for moderate to severe hemoptysis or for mild hemoptysis which was recurrent and not controlled by medical management. Patients referred for surgical intervention and hemoptysis controlled on medical management were excluded.

Results One hundred and thirty patients underwent BAE in the study period. Mean age was 41.5 years and majority (73.1%) was male. Forty-three (33.1%) patients had mild, 46 (35.4%) had moderate, and 41 (31.5%) with the duration of symptoms ranging from 3 days to 25 years. Most common culprit vessel was posterior intercostal artery closely followed by the intercostobronchial artery. Hypervascularity was the most common angiographic abnormality encountered. On an average, 2.75 vessels were embolized per BAE with a wide range of 1 to 8 vessels. Hemoptysis control was seen in 96.1% patients immediately, 90.7 % at 1 month, 82.3 % at 3 months, and 66.9 % at 6 months. Overall recurrence was seen in 43 patients (33.1%). Chest pain was the most common minor side effect occurring in 77.1% cases.

Conclusion BAE is a safe and effective procedure that can be performed routinely in patients presenting with moderate to massive hemoptysis or with mild hemoptysis refractory to medical management.

Ruptured pulmonary artery pseudoaneurysm treated with stent graft: case report and literature review

Background

Hemoptysis is a severe condition, associated with a high mortality rate from asphyxiation. Less than 5% of cases come from the pulmonary arterial circulation and large pseudoaneurysm are rarely treatable by stent graft.

Case presentation

We present the case of a 74-year-old man who suffered from a new onset of hemoptysis despite a prior bronchial artery embolization. He underwent a rescue endovascular stent graft placement for a massive hemoptysis caused by a ruptured proximal pulmonary artery pseudoaneurysm. A short review of similar situations is provided.

Conclusion

Salvage endovascular stent graft placement for a massive hemoptysis caused by a ruptured proximal pulmonary artery pseudoaneurysm is a viable salvage technique for life-threatening hemoptysis.

CIRSE Standards of Practice on Bronchial Artery Embolisation

This CIRSE Standards of Practice document is aimed at interventional radiologists and provides best practices for performing bronchial artery embolisation to effectively treat haemoptysis. It has been developed by an expert writing group established by the CIRSE Standards of Practice Committee.

Microspheres present comparable efficacy and safety profiles compared with polyvinyl alcohol for bronchial artery embolization treatment in hemoptysis patients

Background

The present study aimed to compare the efficacy and safety profiles of microspheres versus (vs.) polyvinyl alcohol (PVA) for bronchial artery embolization (BAE) treatment in patients with hemoptysis.

Methods

Totally, 152 patients with hemoptysis who were about to receive BAE treatment were consecutively enrolled and divided into microspheres group (N = 62) and PVA group (N = 90). Technical success and clinical success were assessed after BAE procedure, and the hemoptysis-recurrence status, survival status and adverse events were recorded during follow-up.

Results

Technical success rates were both 100% in microspheres group and PVA group; clinical success rate (96.8% vs. 100.0%, P = 0.165), 6-month (9.7% vs. 7.8%, P = 0.681) and 1-year (9.7% vs. 8.9%, P = 0.869) hemoptysis recurrence rate, 6-month (4.8% vs. 2.2%, P = 0.374) and 1-year (4.8% vs. 3.3%, P = 0.639) mortality were similar between microspheres group and PVA group. Furthermore, hemoptysis-free survival (P = 0.488) and overall survival (P = 0.321) were of no difference between two groups. In addition, all adverse events were mild, and there was no difference of adverse events between two groups (all P > 0.05). These data were validated by further multivariate regression analysis.

Conclusions

Microspheres present comparable efficacy and safety profiles compared with PVA for the BAE treatment in patients with hemoptysis, providing evidence for embolic agent selection.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12967-021-02947-7.