Bronchial Artery Pseudoaneurysm With Major Hemorrhage After Bronchial Thermoplasty

Nguyen, Dan Vinh; Murin, Susan

doi:10.1016/j.chest.2015.09.016

Cited by 16 publications

(13 citation statements)

References 12 publications

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“…Among the SAE group, additional needs for antibiotics or corticosteroid therapy were observed but significant prolongations of hospital stays were not observed (SAE group, 10.1 days; non-SAE group 6.1 days; p = 0.064) ( Table 3). The previously reported treatments for adverse events after BT included fibrin plug removal by bronchoscopy for atelectasis secondary to occlusion by the plug [5], chest tube insertion for pneumothorax after partial atelectasis [7] and bronchial artery thrombosis and intubation for bronchial artery aneurysm rupture [6]. Such adverse events are the leading causes of death without proper treatment.…”

Section: Discussionmentioning

confidence: 99%

“…The most common complications of BT are transient adverse respiratory events that occur a median of 1 day after the procedure and rarely require hospitalization [4]. Recently, however, serious adverse events (SAEs) involving the airways, which required prolonged hospitalization or threatened the patient's life, have been reported after the BT procedure [5][6][7][8]. Hence, it is necessary to determine early predictors of SAEs after BT to enhance patient safety.…”

Section: Introductionmentioning

confidence: 99%

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Can the Number of Radiofrequency Activations Predict Serious Adverse Events after Bronchial Thermoplasty? A Retrospective Case-Control Study

et al. 2019

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Introduction: Bronchial thermoplasty (BT) is a bronchoscopic procedure that involves the delivery of thermal radiofrequency energy to the bronchial wall for treating severe asthma. It has been suggested that too many radiofrequency activations could induce serious adverse events (SAEs) at an early stage. We aimed to Enhanced digital features To view enhanced digital features for this article go to https://doi.org/10.6084/ m9.figshare.10043030.This study revealed that the number of radiofrequency activations is not associated with SAEs; further studies elucidating the predictive factors for SAEs are required to enhance patient safety

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Can the Number of Radiofrequency Activations Predict Serious Adverse Events after Bronchial Thermoplasty? A Retrospective Case-Control Study

et al. 2019

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“…In rare cases, bronchoscopy is required to remove a plug or cast. Posttreatment episodes of significant airway bleeding have been reported, which in one case report required bronchial artery embolization [37]. Furthermore, pulmonary infections requiring antibiotics have been mentioned, and for this reason the authors recommend a bronchial wash during BT bronchoscopy.…”

Section: Short-term Follow-up and Acute Complication Managementmentioning

confidence: 99%

Bronchial Thermoplasty in Severe Asthma: Best Practice Recommendations from an Expert Panel

et al. 2018

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Bronchial thermoplasty (BT) is a bronchoscopic treatment for patients with severe asthma who remain symptomatic despite optimal medical therapy. In this “expert best practice” paper, the background and practical aspects of BT are highlighted. Randomized, controlled clinical trials have shown BT to be safe and effective in reducing severe exacerbations, improving quality of life, and decreasing emergency department visits. Five-year follow-up studies have provided evidence of the functional stability of BT-treated patients with persistence of a clinical benefit. The Global Initiative for Asthma (GINA) guidelines state that BT can be considered as a treatment option for adult asthma patients at step 5. Patient selection for BT requires close collaboration between interventional pulmonologists and severe asthma specialists. Key patient selection criteria for BT will be reviewed. BT therapy is delivered in 3 separate bronchoscopy sessions at least 3 weeks apart, covering different regions of the lung separately. Patients are treated with 50 mg/day of prednisolone or equivalent for 5 days, starting treatment 3 days prior to the procedure. The procedure is performed under moderate-to-deep sedation or general anesthesia. At bronchoscopy a single-use catheter with a basket design is inserted through the instrument channel and the energy is delivered by a radiofrequency (RF) generator (Alair^TM Bronchial Thermoplasty System). BT uses temperature-controlled RF energy to impact airway remodeling, including a reduction of excessive airway smooth muscle within the airway wall, which has been recognized as a predominant feature of asthma. The treatment should be performed in a systemic manner, starting at the most distal part of the (sub)segmental airway, then moving proximally to the main bronchi, ensuring that the majority of the airways are treated. In general, 40–70 RF activations are provided in the lower lobes, and between 50 and 100 activations in the upper lobes combined. The main periprocedural adverse events are exacerbation of asthma symptoms and increased cough and sputum production. Occasionally, atelectasis has been observed following the procedure. The long-term safety of BT is excellent. An optimized BT responder profile – i.e., which specific asthma phenotype benefits most – is a topic of current research.

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“…There were two cases of pulmonary cysts/pneumothorax (19), and other cases of hemoptysis as serious adverse reactions associated with the BT treatment we performed. Regarding hemoptysis, there are reports in the literature that mediastinal hemorrhage and hemothorax occurred several days after BT treatment, and the cause was pseudo bronchial aneurysm, which was improved by bronchial embolization (20). In the aforementioned AIR2 test, there was a case of hemoptysis and bronchial artery embolization.…”

Section: (98)mentioning

confidence: 98%

Treatment for intractable asthma: bronchial thermoplasty

Sugiyama

Iikura

Ishii

et al. 2019

GHM

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Bronchial Thermoplasty (BT) is an epoch-making treatment that reduces bronchial smooth muscle by using a bronchoscope to reach the basket catheter to the bronchus and directing high-frequency current directly into the bronchi. In GINA Guidelines 2019, BT is considered to be additional treatment at Step V (the most severe), and the evidence level is B. The Japanese guidelines (JGL) also added BT as a treatment for Step 4, but it is reserved because there are still unclear points regarding long-term efficacy and safety. In Japan, as of April 1, 2019, 672 treatments were performed at 123 institutions nationwide. The average age of patients was 54.1 years, but 84 cases were over 70 years old. The average value of %FEV1 was 78.2%, but there were 94 cases less than 60%. There were 32 cases that underwent BT treatment at our institution. Of them, 12 cases with progress up to one year later could be observed. The average age was 56.1 years old, and each of 6 men and women had a %FEV1 of 70.5%. One year later, AQLQ and %FEV1 improved, and the number of exacerbations decreased, but exhaled NO values increased. %FEV1 improvement might be due to poorer lung function (70.5% vs. 77.8%) and more BT activation (average 1.28 times AIR2) compared to the AIR2 trial. In terms of improvement in %FEV1, patients with moderate obstructive disorder from 50 to 80% responded well after BT treatment. In the near future, various new antibody preparations such as IL-4 / 13 antibody and anti-TSLP antibody are expected to be promoted. Therefore, we first consider whether these antibody preparations can be applied to patients with refractory asthma. We consider that BT is indicated only when there is no indication or no expected effect of antibody preparations. In other words, BT treatment is the last resort of intractable asthma, and it is the duty of medical professionals involved in BT treatment to be able to advocate when it is best to give BT to such patients.

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Bronchial Artery Pseudoaneurysm With Major Hemorrhage After Bronchial Thermoplasty

Cited by 16 publications

References 12 publications

Can the Number of Radiofrequency Activations Predict Serious Adverse Events after Bronchial Thermoplasty? A Retrospective Case-Control Study

Can the Number of Radiofrequency Activations Predict Serious Adverse Events after Bronchial Thermoplasty? A Retrospective Case-Control Study

Bronchial Thermoplasty in Severe Asthma: Best Practice Recommendations from an Expert Panel

Treatment for intractable asthma: bronchial thermoplasty

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