Endobronchial Embolization with a Silicone Spigot as a Temporary Treatment for Massive Hemoptysis
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Abstract:
A 39-year-old-woman was treated successfully by a combination of endobronchial and bronchial artery embolization for massive hemorrhage originating from the posterior segment of the right upper lobe. Endobronchial embolization was performed using a silicone spigot placed via flexible bronchoscopy in order to prevent alveolar inundation preceding and during the time of bronchial artery embolization. Massive hemorrhage is a rare and severe condition associated with a high mortality that requires rapid intervention and management. We describe a case that emphasizes the efficacy of a multidisciplinary approach including the use of a new bronchoscopic technique.Keywords:
Bronchial artery
Flexible bronchoscopy
Objective To analyze the causes of non-tumorous recurrent hemoptysis after transcatheter embolization of bronchial artery and to discuss its prevention measures.Methods Transcatheter embolization of bronchial artery was carried out in 152 patients with acute non-tumorous hemoptysis,of whom recurrent hemoptysis within one year occurred in 62,and super-selective angiography of bronchial artery and other systemic arteries were performed again,based on which embolization therapy was repeated.The initial angiography was reviewed.The relationship between the embolization material and the recurrence of non-tumorous hemoptysis was analyzed.Results Hemoptysis recurrence occurred in one week,one,6 and 12 months after embolization was seen in 12,21,36 and 62 cases,respectively.Recurrent hemoptysis in 25 patients was caused by the recanalization of Gelfoam-embolized bronchial artery.The recurrent hemoptysis in 16 patients was due to the missing embolization of diseased bronchial artery branch and in another 9 patients was due to the missing embolization of diseased systemic artery which fed the hemoptysis lesions.The newly-established collateral circulation inside the hemoptysis lesions accounted for the recurrent hemoptysis in 12 patients who had received embolization with Gelfoam particles and micro-spring coils.Conclusion To find out all feeding arteries of hemoptysis lesion,to use un-absorbable embolization particles and to occlude all the feeding arteries completely are the key points for avoiding the recurrent hemoptysis.
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Objective To evaluate the clinical effect of super-selective bronchial artery embolization in the treatment of massive hemoptysis.Methods 52 patients with massive hemoptysis were treated with selective bronchial artery embolization with gelatin sponge particles,gelatin sponge,or combination with steel coils.All patients were followed up for 3 ～ 12 months to observe the recurrence of hemoptysis and complications after bronchial artery embolization.Results All patients were successfully undergone super-selective bronchial artery embolization,and the symptoms gradually disappeared within one week.There were 6 cases of recurrence of hemoptysis 6 ～ 10 months after the bronchial artery embolization,and no serious complications occurred after the embolization.Conclusion The super-selective bronchial artery embolization is a safe and effective method in the treatment of massive hemoptysis.
Bronchial artery
Gelatin sponge
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Objective To evaluate the complications and its related factors of bronchial arterial embolization.Methods Bronchial arterial embolization was performed in 161 cases,26 of them with hemoptysis and the others with lung cancer.Bronchial artery angiograms were taken to confirm the blood supply of lesions.Embolization or chemoembolization was then performed in bronchial artery or its branches.Embolic agents used were Gelfoam particles,PVA and Lipiodol separately.Results Complications happened in 6.2% cases,consisited of spinal cord injury(1.2%),intercoastal artery ischemia(3.7%),and pulmonary arterial embolization(1.2%).Spinal cord injury and intercoastal symptoms occurred with bronchial artery embolization other than its branches.Spinal cord injury happened in PVA group and Lipiodol group,while pulmonary arterial embolization and intercoastal symptoms were seen in Lipiodol group and in all three groups respectively.Conclusion Transcatheter bronchial arterial embolization should be performed carefully.Super-selective catheterization is the method of choice to avoid potential ischemic complications.Gelfoam particles is a relatively safe embolic agent.
Bronchial artery
Lipiodol
Arterial Embolization
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Objective To analyze the relationship of two ways of bronchial artery embolization (BAE) with their effect on different types of phthisic hemoptysis and to study the corresponding optimal way of embolization.Methods 50 patients with secondary phthisic hemoptysis treated by BAE from May,2012 to May,2014 were selected.Among them,28 were treated by the combined embolization of polyvinyl alcohol (PVA) particles and coils and 22 only used PVA particles.15 and 12 cases of chronic fibro-cavitative type,13 and 10 cases of invasive type,21 and 14 cases of recurrent type,7 and 8 cases of initially-treated type,18 and 14 cases of single lung multiple bronchi(＞2 bronchi) offending vessel-related type,and 10 and 8 cases of single lung single bronchus offending vessel-related type were treated by combined embolization or single embolization,respectively.All patients were followed up for 1 to 3 years.The relationship of two different ways of embolization and hemoptysis types with curative effect was investigated.Results 50 patients achieved prompt hemostasis,accounted for 100.0％ (50/50).The overall efficacy (cured + effective) was 78.0％ (39/50).The recurrence rate was 22.0％ (11/50).The overall efficacies for combined embolization of PVA particles and coils and single embolization of PVA alone were 92.9％ (26/28) and 59.1％ (13/22),respectively.There was a statistical difference in effectiveness between combined and single embolization (P＜0.05).Combined embolization had significantly better curative effect (P＜0.05) than single embolization in the treatment of chronic fibro-cavitative,recurrent,and single lung multiple bronchi offending vessel-related hemoptysis.However,in regard to invasive,initially-treated,and single lung single bronchus offending vessel-related hemoptysis,there were no statistical differences between combined and single embolization (P＜0.05).Conclusions BAE is a rapid,effective,minimally invasive,and safe way in the treatment of phthisic hemoptysis and it can adapt to a variety of indications.BAE has been widely applied in clinical practice.Rational selection of embolic materials and embolization methods basing on hemoptysis types is able to further improve the efficacy.
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Objective To evaluate the therapeutic effect,complication and the safety of bronchial artery embolization (BAE) with gelatin sponge for massive hemoptysis caused by pulmonary tuberculosis. Materials and Methods 64 cases of pulmonary tuberculosis with massive hemoptysis (Group A) were retrospectively analyzed. The digital subtracted bronchial arteriogram was perfomed and bleeding arteries were embolized repetitively. 10~15 minutes later, the bronchial artery was repeated embolization utntil it was obturated complately. The same method was applied to obturate other non-bronchial ramus anastomoticus. Other 15 cases as control (Group B) were embolized only once. Results Immediately after embolization, bleeding stopped in 100% in both group A and B. In group A, the short-term efficiency, the long-term efficiency and recurence rate were 95.3%, 60.9% and 39.1% respectively. In group B, the short-term efficiency, the long-term efficiency and recurence rate were 80%, 27% and 73% respectively. There was no significant difference between two groups in the short-term efficiency (P0.05), but has significant difference in the long-term efficiency (P0.05). No serious complications occurred in all cases. Conclusion Bronchial artery embolization is a safe and efficient method for control massive hemoptysis due to pulmonary tuberculosis.Repeated bronchial artery embolization is better than only once embolization. The second embolization should be performed after the first embolization for 15 minutes.
Bronchial artery
Gelatin sponge
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Bronchial artery
Aspergilloma
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Objective To explore the different embolic agents' influences on short-term curative effect in treating hemoptysis by bronchial artery embolization.Methods The subjects were 46 cases of hemoptysis and they were treated by bronchial artery embolization. Before the embolization,angiography was conducted. They were grouped based on whether there existed some lesions that were difficult to embolize because of non-bronchial systemic artery,and then they were embolized by PVA particles and gelatin sponge particles respectively.Results The group of gelatin sponge embolization had the effective rate of 78.3%,while PVA particles 82.6%.In statistical tests,the two groups had no significant difference in efficiency. The poor efficacy of all cases occurred in the non-bronchial systemic artery embolization that was not fully conducted.Conclusion The key to the successful treatment for hemoptysis by the interventional therapy is the full embolization of bronchial and non-bron chial systemic artery. It has no significant influence on short-term effect to choose different embolic agents.
Gelatin sponge
Bronchial artery
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Objective:To investigate the long term effect of bronchial arterial embolization with different material and procedure on patients with hemoptysis in lung disease.Methods:89 cases were divided into groups.One group received the embolizaton of bronchial artery,the other group used gelfoam embolization.49 cases of patients taken superselective bronchial artery perpetual embolization,materials of embolization were coils and Fe 3O 4.40 cases of patients used gelfoam embolization.Results:By comparison there were significant difference on cure rate between these two groups ( P 0.05).Effect of superselective bronchial artery perpetual embolizaton for hemoptysis was better than the gelfoam embolizaton group.Conclusion:Superslelctive bronchial artery perpetual embolization has better effect to treat hemoptysis in lung desease and the recurrent rate is low.
Bronchial artery
Arterial Embolization
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Objective:To investigate the causes and precautions of recurrent hemoptysis after bronchial artery embolization (BAE).Methods:Selective or superselective BAE was performed in 632 patients with hemoptysis.All patients were followed up from 12 to 14 months.Patients with recurrent hemoptysis underwent re-embolization after causes for relapse were identified.Results:Causes of recurrent hemoptysis in a total of 114 cases included missed embolization (n=3),pulmonary collateral supply (n=2),recanalization of previously embolized artery (n=32),nonbronchial systemic collateral supply (n=55) and deterioration of the underlying diseases (n=54).Conclusion:Understanding the causes of recurrence in hemoptysis after embolization treatment is helpful for its prevention.
Bronchial artery
Collateral circulation
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Massive hemoptysis is a frightening and potentially life-threatening clinical event. Patients with chronic inflammatory lung diseases such as bronchiectasis, sarcoidosis, tuberculosis, and cystic fibrosis develop markedly hypertrophied and fragile bronchial arteries that may lead to clinically significant hemoptysis. Surgical intervention is hazardous and often impossible in these patients with diffuse parenchymal lung disease. Superselective catheterization of the bronchial arteries feeding the affected areas followed by particulate embolization has proven to be an effective treatment for the control of bleeding. With modern microcatheters and guidewires, bronchial artery embolization is safe and well tolerated by patients. Because this treatment does not directly influence the primary underlying disease, recurrent episodes of bleeding are likely, which will require additional embolization procedures. In patients who have undergone prior bronchial artery embolization, the dominant feeding arterial supply often originates from nonbronchial systemic collateral vessels.
Bronchial artery
Interventional radiology
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