Massive hemoptysis in pulmonary infections: bronchial artery embolization

Gupta, Amar; Sands, Mark; Chauhan, Nikunj Rashmikant

doi:10.21037/jtd.2018.06.147

Cited by 15 publications

(13 citation statements)

References 31 publications

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“…Interventional embolization is an effective, temporary treatment for massive hemoptysis as a result of the destroyed lung, but recurrence is common (2,5). For patients with infection-related destroyed lungs, especially those with concomitant massive hemoptysis, pneumonectomy is the ultimate treatment (1,(3)(4)(5)(6)(7)(8).…”

Section: Discussionmentioning

confidence: 99%

“…The destroyed lung often occurs as a result of long-lasting lung infection, especially pulmonary tuberculosis. Patients with destroyed lungs who develop aspergilloma usually present with hemoptysis, and interventional embolization of the bronchial artery is a temporary treatment for the control of bleeding under this condition (1,2). However, surgical intervention is the ultimate treatment for the destroyed lung (3)(4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

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Application of preoperative embolization during surgery for the destroyed lung

et al. 2020

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Background: The destroyed lung has been a challenge in the clinical practice of thoracic surgery, and severe adhesions and massive bleeding during surgery are the main obstacles faced by surgeons. This study aimed to investigate the efficacy of the preoperative embolization of blood vessels in adhesions during surgery for the destroyed lung.Methods: A total of 7 patients underwent preoperative embolization for lung resection of destroyed lungs between June 2016 and February 2019. Preoperative embolization was performed for 45 min to 2 h within 48 h before surgery. The embolized arteries included the intercostal artery, radial artery, subclavian artery and their branches, and the number of embolized arteries ranged from 5 to 13.Results: A posterolateral incision was made in these patients, and endoscope-assisted separation of the adhesions at the top of the chest wall and on the lateral chest wall was performed. The operation time ranged from 3.5 to 8 h, and the blood loss was 1,200-5,000 mL. The postoperative drainage was in the normal range. One patient developed multiple organ failure and bronchopleural fistulas (BPF) one month after surgery, which was resolved after active drainage and argon cauterization; another patient developed BPF 7 months after surgery, which was resolved after placement of a nonreturn valve in the subsegmental bronchi via bronchoscopy.Conclusions: Surgery of the destroyed lung is a great challenge in clinical practice, mainly due to the risk of the blood supply in the adhesions. Preoperative embolization may reduce intraoperative blood loss and surgical difficulty.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Application of preoperative embolization during surgery for the destroyed lung

et al. 2020

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“…In this non-surgical minimally invasive treatment, during aortography, hemostasis of the bleeding vessel is attained using very fine particles or coils or gel foams [10][11][12][13]. Due to the high mortality rate of massive hemoptysis, taking emergent diagnostic and therapeutic measures by an experienced team consisting of a thorax surgeon, a pulmonologist, an anesthesiologist, radiologist or interventional cardiologist will help save the patient's life [7].…”

Section: Discussionmentioning

confidence: 99%

“…Airway protection is performed using a single lumen tube along with a balloon blocker as the recommended method or a double lumens trachea tube. If possible, diagnostic tests are performed to determine the location and type of lesion [7].…”

Section: Introductionmentioning

confidence: 99%

Preemptive non-selective bronchial artery angioembolization to reduce recurrence rate of hemoptysis

et al. 2020

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Background: Massive hemoptysis which is presented in advanced lung diseases is a life-threatening condition. Bronchial artery embolization as a minimally invasive procedure is the treatment of choice either in first or recurrent hemoptysis. This study aimed to assess the early and late efficacy of bronchial angioembolization (BAE) without microcatheter.Methods: In this prospective cohort study, all patients with hemoptysis who had undergone BAE from August 2018 to March 2019 were included. Angiographic patterns including bleeding sources, number of involved vessels, the underlying etiology, and recurrence rate were evaluated in a one-year follow-up.Results: 153 patients were included with mean age of 55 ±16 years. 68% of them were male and 58% had life-threatening massive hemoptysis. Three distinct angiographic patterns were recognized. The culprit bleeding vessel was bronchial in 126 (92%), intercostal in 4 (3%), and both vessels in 7 (5%) of cases (P<0.05). One vessel involvement was seen in 56 patients; however it was observed in 69% of non-cystic fibrosis lobar bronchiectasis patients. In 1, 3 and 12 months follow up, recurrent hemoptysis was reported in 15 (11%), 4 (2.5%), and 24 (15.5%), respectively. In 52% of cases, no abnormal vessels were observed during aorta injection, but culprit bronchial or intercostal arteries were found in selective investigational angiography.Conclusion: BAE was successful in the control of hemoptysis and resulted in a low rate of recurrence in different types of lung diseases. This could be due to the embolization of all pathological arteries found during angiography which might have prevented recurrent bleeding.

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“…BAE is recommended for hemoptysis patients, with a recurrence-free procedure success rate of approximately 90% (18). Previous studies have reported the recurrent hemoptysis rate to be approximately 10-30% (18).…”

Section: Discussionmentioning

confidence: 99%

A retrospective analysis of risk factors in recurrent hemoptysis patients with non-bronchial systematic artery feeding

Zhang¹,

Zheng²,

Zhao³

et al. 2020

Ann Transl Med

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Background: Hemoptysis is a symptom of a life-threatening condition. Bronchial artery embolization (BAE) is recommended to control hemoptysis. However, non-bronchial systematic arteries (NBSAs) can be culprit vessels, particularly in recurrent hemoptysis patients after embolization, according to recent studies. Therefore, the purpose of the present study was to retrospectively assess the risk factors of recurrent hemoptysis patients with NBSA feeding after interventional embolization.Methods: Between January 2014 and December 2017, a total of 545 patients underwent interventional embolization for hemoptysis. A total of 93 patients who were confirmed to have NBSA feeding and underwent embolization were enrolled. Patients' demographic characteristics, clinical information, laboratory tests, imaging findings, and embolization outcomes were reviewed. The Kaplan-Meier method and logistic regression analysis were performed for recurrence-free survival rates and risk factors associated with rebleeding, respectively.Results: Clinical success was achieved in 40.9% (9/22) of patients who underwent embolization prior to computed tomography (CT) bronchial arteriography (BA), and in 98.6% (70/71) of patients who underwent CTBA first. The median follow-up duration was 511 days (range, 1-1,539 days). CTBA performed after the first embolization (P<0.001) and elevated pre-embolization C-reactive protein (P<0.05) were associated with hemoptysis recurrence in multivariate regression analyses.Conclusions: Multidetector CTBA was recommended prior to embolization, as it shows the diagnostic value for detecting NBSA. Elevated pre-embolization C-reactive protein was found to be associated with rebleeding after embolization.

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Massive hemoptysis in pulmonary infections: bronchial artery embolization

Cited by 15 publications

References 31 publications

Application of preoperative embolization during surgery for the destroyed lung

Application of preoperative embolization during surgery for the destroyed lung

Preemptive non-selective bronchial artery angioembolization to reduce recurrence rate of hemoptysis

A retrospective analysis of risk factors in recurrent hemoptysis patients with non-bronchial systematic artery feeding

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