Comparison of the Effectiveness of Embolic Agents for Bronchial Artery Embolization: Gelfoam versus Polyvinyl Alcohol

Abstract

ObjectiveThe purpose of this study was to compare the results of different agents for bronchial artery embolization of hemoptysis.Materials and MethodsFrom March 1992 to December 2006, a bronchial artery embolization was performed on 430 patients with hemoptysis. The patients were divided into three groups. Group 1 included 74 patients treated with a gelfoam particle (1×1×1 mm), while group 2 comprised of 205 patients treated with polyvinyl alcohol (PVA) at 355-500 µm, and group 3 included 151 patients treated with PVA at 500-710 µm. We categorized the results as technical and clinical successes, and also included the mid-term results. Retrospectively, the technical success was compared immediately after the procedure. The clinical success and mid-term results (percentage of patients who were free of hemoptysis) were compared at 1 and 12 months after the procedure, respectively.ResultsNeither the technical successes (group 1; 85%, 2; 85%, 3; 90%) nor the clinical successes (group 1; 72%, 2; 74%, 3; 71%) showed a significant difference among the 3 groups (p > 0.05). However, the mid-term results (group 1; 45%, 2; 63%, 3; 62%) and mid-term results excluding the recurrence from collateral vessels in each of the groups (group 1; 1 patient, 2; 4 patients, 3; 2 patients) showed that group 1 was lower than the other two groups (p < 0.05). No significant difference was discovered for the mid-term results between groups 2 and 3. Moreover, the same results not including incidences of recurrence from collateral vessels also showed no statistical significance between the two groups (p > 0.05).ConclusionPolyvinyl alcohol appears to be the more optimal modality compared to gelfoam particle for bronchial artery embolization in order to improve the mid-term results. The material size of PVA needs to be selected to match with the vascular diameter.

Radiologic Management of Haemoptysis: Diagnostic and Interventional Bronchial Arterial Embolisation

“…However, the technical and primary success rate (up to 1 month post-BAE) for both particle types did not differ [99]. In this study, results were not dependent on particle size (355 -500 μm vs. 500 -710 μm).…”

“…sion of recurrent hemoptysis resulting from using PVA particles (355 -500 μm and 500 -710 μm) compared to gelatin sponges (1 (mm)³) is significantly greater (62 -63 % vs. 45 %) [99]. However, the technical and primary success rate (up to 1 month post-BAE) for both particle types did not differ [99].…”

Mechanisms of recurrent haemoptysis after super-selective bronchial artery coil embolisation: a single-centre retrospective observational study

“…Recanalisation and the development of new HRAs caused more that 80% of the HRAs at the 2nd series ssBACE. In contrast to PVA and NBCA, which serve as bloodstreamdependent linear liquid embolisation materials, ssBACE provides patients with controlled pinpoint embolisation of target HRAs [10][11][12][13][14][15][16][17]. In light of this, we speculate that the most common mechanism of recurrent haemoptysis, namely recanalisation, may occur more frequently during ssBACE compared to BAE performed with PVA or NBCA.…”

“…As a result of the significant negative impact of massive haemoptysis on a patient's quality of life and risk of mortality, an interventional radiological approach known as bronchial artery embolisation (BAE) has been introduced and evaluated extensively [7][8][9][10][11][12][13][14]. In addition, interest has recently started to shift to long-term haemoptysis-free survival rather than shortterm haemostatic rate, since short-term haemostasis can be achieved in the majority of cases owing to advancements in interventional devices and medical knowledge [9][10][11][12][13][14][15][16][17]. For example, BAE performed using polyvinyl alcohol (PVA) or N-butyl-2-cyanoacrylate (NBCA), or using a metallic coil, has been shown to produce much more favourable long-term outcomes compared to BAE performed using a gelatin sponge [14,16].…”

“…The largest observational studies to date have shown that the estimated 1-year haemoptysis-free survival rates for BAE performed using PVA, NBCA and a metallic coil are 77%, 88% and 87%, respectively [14,16]. However, little evidence is available on the mechanisms of recurrent haemoptysis after BAE using metallic coil [11][12][13][14][15][16][17]. The aim of the present study was to evaluate the mechanisms of recurrent haemoptysis using both enhanced-computed tomography (e-CT) and cineangiography after super-selective bronchial artery coil embolisation (ssBACE) by reviewing 299 haemoptysis-related arteries (HRAs) from 57 consecutive patients who underwent 2nd series ssBACE for the management of recurrent haemoptysis.…”