A Retrospective Analysis of 334 Cases of Hemoptysis Treated by Bronchial Artery Embolization

Bhalla, Ashu Seith; Kandasamy, Devasenathipathy; Veedu, Prasad Thotton; Mohan, Anant; Gamanagatti, Shivanand

doi:10.5001/omj.2015.26

Cited by 40 publications

(29 citation statements)

References 21 publications

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“…The most common etiologies were cryptogenic hemoptysis (18%) and NTM (18%), followed by bronchiectasis (15%) and pulmonary aspergillosis (15%). Some studies performed in Asian countries other than Japan have reported that pulmonary tuberculosis and its sequelae comprised the largest group of etiologies for hemoptysis [10,11,14]. However, in Japan, bronchiectasis, NTM, and cryptogenic hemoptysis were reported to be common etiologies in patients treated with BAE [4], which is similar to our present findings.…”

Section: Discussionsupporting

confidence: 90%

“…The 6% rate in our study is better than these reported rates of recurrence. Short-term recurrence might occur because of failure to identify or embolize the bleeding vessels in the first setting or the nature of the primary disease is unresponsive to BAE [14]. Thus, it is important to perform a complete embolization for involved arteries including the bronchial and non-bronchial arteries.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Features, Outcomes, and Predictors of Recurrence in Patients Treated with Bronchial Arterial Embolization Using a Gelatin Sponge to Control Hemoptysis

Wada

Furuya

Ike

et al. 2019

Interventional Radiology

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Objective: The clinical features and outcomes of bronchial arterial embolization (BAE) for hemoptysis were investigated, and we aimed to identify the factors associated with recurrent hemoptysis after BAE. Patients and Methods: Thirty-three consecutive patients treated with BAE for hemoptysis between July 2011 and June 2018 in a single medical center were retrospectively analyzed. Sex, age, body mass index, smoking history, comorbidity, laboratory data, etiology, angiographic findings, number and variety of embolized vessels, adverse events, and outcomes were evaluated. Results: The median age at the time of first BAE was 71 years (interquartile range [IQR], 59.5-86.5 years). The most common etiologies were cryptogenic hemoptysis (n=6), non-tuberculosis mycobacteriosis (n=6), pulmonary aspergillosis (n=5), bronchiectasis (n=5), and others (n=11). The common angiographic findings were neo-vascularization (n=31) and hypertrophied vessels (n=19). Eight patients (24%) experienced recurrence after BAE during the median follow-up time of 15 months (IQR, 4-25.5 months), and recurrence occurred in two patients (6%) within 1 month and in one patient (3%) after 3 years. The recurrence-free time after BAE was significantly shorter in patients with !20 pack-years smoking history (p=0.0218) and patients using anticoagulants or antiplatelet agents (p=0.0032). No moderate to severe adverse events related to BAE were encountered. Conclusion: BAE is a safe and effective treatment to control hemoptysis. However, recurrence occurred in 24% of our patient series. A smoking history of !20 pack-years and the use of anticoagulants or antiplatelet agents may be associated with a higher rate of recurrent hemoptysis following BAE.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Clinical Features, Outcomes, and Predictors of Recurrence in Patients Treated with Bronchial Arterial Embolization Using a Gelatin Sponge to Control Hemoptysis

Wada

Furuya

Ike

et al. 2019

Interventional Radiology

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“…It is important to remember that most hemoptysis originate from the bronchial circulation, but in rare cases, hemoptysis may originate from the pulmonary circulation. Recent studies have shown the effectiveness of BAE in a wide array of pathologies including tuberculosis, bronchiectasis, aspergilloma, and malignancy [ 50 – 53 ]. Embolizing agents are numerous, but polyvinyl alcohol (usually 300–600 µ m) is the most frequently used, having the advantage of being nonabsorbable and available in different sizes [ 54 , 55 ].…”

Section: Treatmentmentioning

confidence: 99%

Approach to Hemoptysis in the Modern Era

Gagnon

Quigley

Dutau

et al. 2017

Canadian Respiratory Journal

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Hemoptysis is a frequent manifestation of a wide variety of diseases, with mild to life-threatening presentations. The diagnostic workup and the management of severe hemoptysis are often challenging. Advances in endoscopic techniques have led to different new therapeutic approaches. Cold saline, vasoconstrictive and antifibrinolytic agents, oxidized regenerated cellulose, biocompatible glue, laser photocoagulation, argon plasma coagulation, and endobronchial stents and valves are amongst the tools available to the bronchoscopist. In this article, we review the evidence regarding the definition, etiology, diagnostic modalities, and treatment of severe hemoptysis in the modern era with emphasis on bronchoscopic techniques.

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“…The early recurrence rate of 10% in the present study can be attributed to the inability to embolize third or higher order branches due to extensive collateralization. Late recurrences are postulated to occur due to reconstitution of previously embolized arteries or underlying disease progression causing recruitment of new arteries [ 10 , 15 , 21 – 25 ]. Of these, 3 patients had large AV shunts and were embolized with decremental PVA particle size as discussed above.…”

Section: Discussionmentioning

confidence: 99%

“…The remaining 2 patients with AV shunt did not have any hemoptysis until the 12-month follow-up. A comparison between grade of hemoptysis, embolizing agent used, immediate clinical success and overall recurrence is made in Table I [ 9 , 13 , 15 , 21 , 26 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

Bronchial artery embolization. What further we can offer?

Tayal

Chauhan

Sharma

et al. 2019

Videosurgery and Other Miniinvasive Techniques

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Introduction Massive hemoptysis is the most feared of all respiratory emergencies, with many underlying causes. In 90% of cases, the source of hemoptysis is the bronchial circulation. Despite high recurrence rates, bronchial artery embolization (BAE) remains the first-line treatment in management of hemoptysis. Aim To establish pre-procedure and procedural protocols for BAE. Material and methods The study included a total of 50 patients referred to the Department of Radiology for complaints of hemoptysis. Pre-procedure computed tomography (CT) angiography for determination of responsible circulation was performed as a regular protocol except in cases presenting with life-threatening hemoptysis. Polyvinyl alcohol (PVA size, 300–500 μm and 500–700 μm) particles combined with gel foam embolization was performed. Successful catheterization and embolization of the targeted vessel was considered technical success and the cessation of hemoptysis to minimal levels was labeled clinical success. Results Thirty-two (64%) male and 18 (36%) female subjects comprised the study group. Forty (80%) patients had moderate to severe hemoptysis. Tuberculosis (80%) was the most common etiology. Five patients had severe AV shunting and were embolized with decremental particle size (500–700 μm followed by 300–500 μm) to occlude the bed and then embolize the artery. Technical success was achieved in all the patients, but clinical success was achieved in 40 (80%) patients. Conclusions Bronchial artery embolization is a minimally invasive procedure recognized for primary management of hemoptysis. Preprocedure evaluation with CT angiography can add incremental value in management. Usage of decremental particle size is helpful to embolize large AV shunts.

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A Retrospective Analysis of 334 Cases of Hemoptysis Treated by Bronchial Artery Embolization

Abstract: BAE is a safe and effective procedure with a negligible complication rate. Our approach of targeting hypertrophied arteries was effective.

Cited by 40 publications

References 21 publications

Clinical Features, Outcomes, and Predictors of Recurrence in Patients Treated with Bronchial Arterial Embolization Using a Gelatin Sponge to Control Hemoptysis

Clinical Features, Outcomes, and Predictors of Recurrence in Patients Treated with Bronchial Arterial Embolization Using a Gelatin Sponge to Control Hemoptysis

Approach to Hemoptysis in the Modern Era

Bronchial artery embolization. What further we can offer?

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