Arterial embolization as preoperative treatment for pulmonary aspergillosis with hemoptysis

Abstract

Pulmonary aspergillosis associated with old tuberculosis is generally resistant to treatment. Thus, if patients are treated only with conservative therapy, their condition continues to deteriorate due to repetitive hemoptysis, and may even become critical. Surgical treatment is required for these patients; however, it is extremely difficult to resect the lesion due to severe adhesions to the chest wall and vascular proliferation surrounding the lesion. We performed preoperative arterial embolization, achieving good results in three patients with hemoptysis caused by pulmonary aspergillosis. The feeding arteries were embolized using microcoils and/or gelatin sponges, and a lobectomy was safely carried out in all patients. We concluded that preoperative arterial embolization is a safe and effective technique to prevent massive hemorrhage occurring at the time of surgery.

Chest-Wall Collateral Embolization to Reduce Surgical Blood Loss in Peripheral Aspergillomas

“…13,14 Studies have reported blood loss up to 4 to 5 L while performing these resections. 26,[30][31][32][33] While inferiorly located adhesions are easy to visualize and dissect, a major culprit is the highly vascular apical adhesions. These pose a problem because most of the aspergillomas are located in the lung apices, since they commonly occur in the setting of posttubercular sequelae.…”

“…These apical aspergillomas are difficult to visualize, more vascular, and have close proximity to the subclavian vessels, leading to excessive bleeding. 26,34 Surgeons have attempted to control this torrential bleeding with the use of techniques such as leaving a part of lung parenchyma attached to the wall, dividing using staplers, and performing extra-pleural resection. 26 However, these are fraught with problems of subsequent infection and rebleeding.…”

“…26,34 Surgeons have attempted to control this torrential bleeding with the use of techniques such as leaving a part of lung parenchyma attached to the wall, dividing using staplers, and performing extra-pleural resection. 26 However, these are fraught with problems of subsequent infection and rebleeding.…”

“…[19][20][21] Centrally located lesions pose difficulty during the dissection of pulmonary vessels, while the extension of the disease across the fissures further adds to the surgical woes. [22][23][24][25] Otani et al 26 first described preoperative embolization to prevent severe bleeding during surgery for PAs in three patients. They embolized both bronchial and non-bronchial systemic collaterals 2 weeks prior to surgery.…”

Treatment of fungal infections in adult pulmonary and critical care patients

“…Рандомизированных исследований этой пато логии немного. При массивном кровохарканье тре буется неотложная эмболизация бронхиальных арте рий, которая может спасти жизнь больному (класс рекомендаций ВII) [235][236][237]. Нередко после эмбо лизации наблюдается повторное легочное кровотече ние, что требует консультации торакального хирурга.…”