Percutaneous Embolotherapy for Life-Threatening Hemoptysis

Wong, Michelle; Szkup, Peter; Hopley, Mark

doi:10.1378/chest.121.1.95

Cited by 110 publications

(56 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Pleural thickening has already been shown to be associated with nonbronchial systemic supply, failure of identification of which may lead to recurrent haemoptysis [15,27,28]. Multiple non-bronchial systemic arteries were detected in this study with as many as 12 different arteries in a single patient and this indicates the need for a search for such arteries prior to embolotherapy in order to prevent recurrent haemoptysis.…”

Section: Discussionmentioning

confidence: 53%

64-detector row CT evaluation of bronchial and non-bronchial systemic arteries in life-threatening haemoptysis

Ponnuswamy¹,

Sankaravadivelu²,

Maduraimuthu³

et al. 2012

BJR

View full text Add to dashboard Cite

Objective: To retrospectively evaluate the depiction of bronchial and non-bronchial systemic arteries with 64-detector row CT in patients undergoing endovascular treatment for life-threatening haemoptysis. Methods: 64-detector row helical CT and conventional angiography of the thorax were performed in 28 patients (25 males, 3 females; age range, 18-65 years; mean age, 40 years) with life-threatening haemoptysis. CT images were analysed to identify abnormal bronchial and non-bronchial systemic arteries and also to localise them in two planes. Results: Using multidetector CT (MDCT), 43 bronchial arteries were identified on the right side and 46 on the left side. 89% of the right bronchial arteries originated from the right intercostobronchial arteries. A common trunk of origin of the right and left bronchial artery was noted in 46% of cases. 23 non-bronchial systemic arteries were noted on the right side and 41 on the left side. Pleural thickening .3 mm was confirmed to be a good predictor of non-bronchial systemic supply. An internal mammary artery diameter of .3 mm and an inferior phrenic artery diameter of .2 mm were sensitive indicators for non-bronchial systemic supply. Conclusion: MDCT is a good investigation tool for evaluating life-threatening haemoptysis as it confirms the disease process, identifies the origin and ostial position of bronchial arteries, detects non-bronchial systemic arteries and acts as a roadmap for percutaneous transcatheter embolisation.

show abstract

Section: Discussionmentioning

confidence: 53%

64-detector row CT evaluation of bronchial and non-bronchial systemic arteries in life-threatening haemoptysis

Ponnuswamy¹,

Sankaravadivelu²,

Maduraimuthu³

et al. 2012

BJR

View full text Add to dashboard Cite

show abstract

“…The most disastrous complication after bronchial artery embolization is spinal cord ischemia due to the occlusion of spinal arteries, which has been reported in 0-6.5% of cases [20][21][22][23]. Visualization of radicular branches on bronchial or intercostal angiograms is not an absolute contraindication to embolization.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Embolization of Hypervascular Castleman’s Disease of the Mediastinum

Robert

Sgourdos

Kritikos

et al. 2007

Cardiovasc Intervent Radiol

View full text Add to dashboard Cite

We report the case of a 31-year-old woman with mediastinal CastlemanÕs disease of the hyaline vascular type. This large tumor was safely resected after arterial embolization. We describe the steps of this interventional procedure and discuss related necessary precautions.Key words: CastlemanÕs disease-Hypervasular tumors-Mediastinum-Arterial embolization CastlemanÕs disease (CD) is a rare form of lymph node hyperplasia, most commonly presenting as a solitary mediastinal mass. Computed tomography (CT) and angiographic features of CD are nonspecific [1] and a definite diagnosis is only based on histology findings. The surgical approach is usually curative when the disease is unicentric [2], but it is frequently associated with profuse bleeding. Only a few previous reports have suggested arterial embolization in the preoperative management of CD [3,4]. We report a case of localized CD presenting as a voluminous mass in the posterior mediastinum. Preoperative arterial embolization of this tumor minimized intraoperative bleeding. Case ReportA 31-year-old nonsmoking Asian woman with no medical history presented with a dry cough for 6 months without any other symptoms. An abnormal opacity in the posterior mediastinum was found on chest X-ray (Figs. 1A and 1B). CT confirmed the presence of a 12-cm homogeneous, welldelineated hypervascular right paravertebral mass of the posterior mediastinum (Fig. 1C). There was no evidence of pleural fluid or bone invasion. Laboratory investigations were within the normal range. Fine-needle aspiration or needle-core biopsy was not performed considering the risk of bleeding from this hypervascular mass and because of its location.A preoperative descending thoracic aortogram was obtained by means of a 5F pigtail catheter (Cordis, Roden, The Netherlands), in order to visualize the origin of the bronchial and extrabronchial arteries from the aorta. A selective bronchial arteriography by means of a 5F steam-modified Cobra catheter (Cordis, Roden, The Netherlands) supported the presence of a hypervascular mediastinal mass. The lesion was exclusively supplied by two arterial branches of a broncho-intercostal trunk originating from the descending thoracic aorta; it drained into large uphill inferior esophageal varices (Fig. 2). In a second step, embolization of these two feeding arteries was performed, in order to minimize intraoperative bleeding. The superior arterial branch, which supplied the superior and lateral portions of the mass, was selectively catheterized with a 2.5F microcatheter (Tracker 18; Boston Scientific, Cork, Ireland) and embolized by means of gelatin cross-linked tris-acryl microspheres 500-750 lm in diameter (Embospheres; Biosphere Medical, Roissy-Charles-de-Gaulle, France). Occlusion of the proximal segment was completed by three 3-0 silk threads (Silkam; Aesculap, Tuttlingen, Germany). The second arterial branch, which supplied the inferior and medial portions of the mass, was superselectively catheterized beyond the left bronchial artery and embolized in the sa...

show abstract

“…Transverse myelitis due to spinal cord ischemia is the most serious complication associated with the embolization of the bronchial circulation. This complication is reported to occur at a rate of 1.4-6.5% [7,8,9]. The use of super selective micro catheter techniques with positioning of the catheter tip distal to the anterior medullary artery has reportedly reduced the incidence of this complication.…”

Section: To the Thoracic Surgeon Andmentioning

confidence: 99%

Management considerations of massive hemoptysis while on extracorporeal membrane oxygenation

et al. 2016

View full text Add to dashboard Cite

Background: Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is a life-saving procedure in patients with both respiratory and cardiac failure. Bleeding complications are common since patients must be maintained on anticoagulation. Massive hemoptysis is a rare complication of ECMO; however, it may result in death if not managed thoughtfully and expeditiously. Methods: A retrospective chart review was performed of consecutive ECMO patients from 7/2010-8/2014 to identify episodes of massive hemoptysis. The management of and the outcomes in these patients were studied. Massive hemoptysis was defined as an inability to control bleeding (>300 mL/day) from the endotracheal tube with conventional maneuvers, such as bronchoscopy with cold saline lavage, diluted epinephrine lavage and selective lung isolation. All of these episodes necessitated disconnecting the ventilator tubing and clamping the endotracheal tube, causing full airway tamponade. Results: During the period of review, we identified 118 patients on ECMO and 3 (2.5%) patients had the complication of massive hemoptysis. One case was directly related to pulmonary catheter migration and the other two were spontaneous bleeding events that were propagated by antiplatelet agents. All three patients underwent bronchial artery embolization in the interventional radiology suite. Anticoagulation was held during the period of massive hemoptysis without any embolic complications. There was no recurrent bleed after appropriate intervention. All three patients were successfully separated from ECMO. Conclusions: Bleeding complications remain a major issue in patients on ECMO. Disconnection of the ventilator and clamping the endotracheal tube with full respiratory and cardiac support by V-A ECMO is safe. Early involvement of interventional radiology to embolize any potential sources of the bleed can prevent re-hemoptysis and enable continued cardiac and respiratory recovery.

show abstract

Percutaneous Embolotherapy for Life-Threatening Hemoptysis

Cited by 110 publications

References 37 publications

64-detector row CT evaluation of bronchial and non-bronchial systemic arteries in life-threatening haemoptysis

64-detector row CT evaluation of bronchial and non-bronchial systemic arteries in life-threatening haemoptysis

Preoperative Embolization of Hypervascular Castleman’s Disease of the Mediastinum

Management considerations of massive hemoptysis while on extracorporeal membrane oxygenation

Contact Info

Product

Resources

About