Predilatation of a stenotic ostium of a bronchial artery, followed by embolization in recurrent hemoptysis

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Abstract

Bronchial artery embolization may be the only life-saving procedure available in a patient presenting with massive hemoptysis. Rarely, selective catheterization of these vessels may be rendered difficult due to a stenotic ostium. This may result in closure of the vessel or absence of forward flow after the stenotic segment is crossed with a diagnostic catheter or a microcatheter. Further, it may also lead to recurrence of hemoptysis if the distal vessel and the prearteriolar bed are inadequately embolized. We describe a technique of selective cannulation of the stenotic vessel, dilatation of the stenosis and then successful embolization.

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Immediate and long-term results of bronchial artery embolization for life-threatening hemoptysis.

Hervé Mal, Isabelle Rullon, Francois Mellot … (1999)

Bronchial artery embolization (BAE) has been established as an effective technique in the emergency treatment of life-threatening hemoptysis, but few data concerning long-term results and complications of the procedure are available. The aim of this study was to analyze retrospectively the experience of BAE in our center with particular emphasis on medium-term and long-term results and on morbidity. University hospital. Fifty-six patients underwent bronchial arteriography from 1986 to 1996 in our center for the management of life-threatening hemoptysis. Of them, BAE was performed in 46 patients. Their mean age was 51 years (range, 19 to 89 years). The most frequent etiologies of hemoptysis were active or inactive tuberculosis, bronchiectasis, or idiopathic hemoptysis. BAE resulted in an immediate cessation of hemoptysis in 43 of the initial 56 patients (77%). During the first month after BAE, four patients who died from causes other than hemoptysis or who were referred to surgery were excluded from follow-up and in the 39 remaining patients, a complete cessation of hemoptysis was observed in 32 patients. A remission was noted in 28 of the 29 patients followed up between 30 and 90 days after BAE. Long-term control of bleeding was achieved in 25 of the initial 56 patients (45%) followed up beyond 3 months after BAE (median follow-up of 13 months; range, 3 to 76 months). Overall, complications of BAE consisted of two episodes of mediastinal hematoma and three episodes of neurologic damage, two of which improved without permanent sequelae. We conclude that BAE may result in long-term as well as immediate control of life-threatening hemoptysis but that complications are not unusual.

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Management and prognosis of massive hemoptysis. Recent experience with 120 patients.

Christopher J Knott-Craig, J. Gerhard Oostuizen, Gawie Rossouw … (1993)

A retrospective analysis was done of 120 consecutive patients with life-threatening hemoptysis (greater than 200 ml of discharge per 24 hours) cared for between 1983 and 1990 at our institution. Seventy-nine percent of the patients (95/120) had hemoptysis exceeding 500 ml/24 hr. Inflammatory lung disease was the underlying cause in at least 85% of cases (n = 103); and of these, pulmonary tuberculosis was the primary diagnosis in 85% (88/103). Fifty-two patients (43%) had had a prior episode of massive hemoptysis, usually within 3 months of their admission. Urgent examination with rigid endoscope in 97 patients (81%) localized the bleeding in only 42 (43%). The overall hospital mortality rate was 10% (12/120) and was similar for those having pulmonary resection (7.1%, 3/42), and those assisted medically (11.5%, 9/78) (p = not significant). However, of these hospital survivors on whom 6-month follow-up was available, 36.4% (20/55) of those with medical management and none (0/39) (p < 0.001) of those with surgical management had recurrent massive hemoptysis. Forty-five percent of these cases were fatal. Current management of massive hemoptysis has resulted in improved hospital outcome. However, the high risk of recurrent and often fatal hemoptysis mandates the definitive management of the bronchial arteries before discharge from the hospital. Recent reports suggest that percutaneous embolization may be effective in nonsurgical candidates.

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Surgical management of massive hemoptysis. A ten-year experience.

E Garzón, A Gourin (1978)

Pulmonary bleeding was defined as massive when the collected blood was 600 ml or more in 24 hours. Hemoptysis of this magnitude carries more than 50% mortality when managed without surgical intervention, For this reason all patients admitted, bleeding massively, in the past ten years were considered candidates for surgical therapy. Localization of the bleeding was done by bronchoscopy. Pulmonary reserve was evaluated by clinical and radiological observation and, when feasible, by spirometry. Of the 75 patients seen with massive hemoptysis, 68 were operated. Seven patients were excluded for various reasons. Five of these patients died during the acute bleeding episode. Sixt-five resections were performed with 11 deaths (17%) and three cavernostomies with one death. Of 51 lobectomies, seven expired (14%). One segmentectomy survived. Other than the magnitude of the surgical resection, the mortality was related to the amount of bleeding in the 24 hours preceding the surgical procedure. Severe bleeding at the time of resection requiring one-lung ventilation also significantly influenced the mortality (33% against 7%). This experience shows that pulmonary resection is the treatment of choice in patients with massive hemoptysis.

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Journal

Journal ID (nlm-ta): Indian J Radiol Imaging

Journal ID (publisher-id): IJRI

Title: The Indian Journal of Radiology & Imaging

Publisher: Medknow Publications (India )

ISSN (Print): 0971-3026

ISSN (Electronic): 1998-3808

Publication date (Print): August 2010

Volume: 20

Issue: 3

Pages: 221-223

Affiliations

Department of Radiology, Kovai Medical Center and Hospital, Avinashi Road, Coimbatore, Tamil Nadu – 641 014, India

Author notes

Correspondence: Dr. Mathew Cherian, Department of Radiology, Kovai Medical Center and Hospital, Avinashi Road, Coimbatore, Tamil Nadu – 641 014, India. E-mail: dr.mathewcherian@ 123456gmail.com

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Publisher ID: IJRI-20-221

DOI: 10.4103/0971-3026.69363

PMC ID: 2963750

PubMed ID: 21042451

SO-VID: 64b7c937-6b0d-443b-8066-274ae2b2ea53

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This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Predilatation of a stenotic ostium of a bronchial artery, followed by embolization in recurrent hemoptysis

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Most cited references 6

Immediate and long-term results of bronchial artery embolization for life-threatening hemoptysis.

Management and prognosis of massive hemoptysis. Recent experience with 120 patients.

Surgical management of massive hemoptysis. A ten-year experience.

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