Bronchial Artery and Non-bronchial Systemic Artery Embolization for the Treatment in Patients with Hemoptysis: Analysis of Efficacy of Gelfoam Single Use

PURPOSE: To investigate the efficacy of Gelfoam single use for the management of hemoptysis by analyzing patients with recurrence in embolized artery and other artery, respectively. MATERIALS AND METHODS: Between 1992 and 2000, 131 patients (104 men and 27 women, mean age: 54.4 years) with hemoptysis underwent BAE using gelatin sponge only. After puncturing the femoral artery using the Seldinger method, angiographies of the thoracic aorta, the bronchial arteries, the intercostal arteries, and the systemic collaterals which were suspected of bleeding focus and embolization were performed. Gelfoam was used 1x3 mm and 2x3 mm or 2x5 mm by the diameter of feeding arteries. The cumulative hemoptysis control rate and recurrence rate were analyzed from the previously embolized vessels. RESULTS: Hemoptysis were recurred among 34 of 131 patients. Twenty-two patients had a recurrence from the same vessels and 12 from the different ones. Using the Kaplan-Meier method, the cumulative hemoptysis control rate was obtained in the patients with a recurrence from the same vessels: 88.8% in 1 month, 79.9% in 1 year, and 77.3% in 2 year. The reasons for recurrences of the same lesions are as follows; due to the tortuosity of the vessel (n=3); partial embolization through the common trunk formation between bronchial and anterior spinal artery (n=3); by vessel spasms or autogenous thrombus (n=2); due to the contrast media hypersensitivity (n=1). These 9 patients were not treated successfully. In the remaining 13 cases, hemoptysis were recurred due to recanalization of embolized vessels. Among 161 procedure, complications consisted of fever (n=8), dyspnea (n=8), mild chest discomfort (n=7), lower back pain (n=1), and transient lower leg paralysis (n=1), which were improved within several days. There was no serious complication in this study. CONCLUSION: Bronchial artery embolization using Gelfoam alone maybe effective and safe to control hemoptysis.

Recurrent Bleeding After Arterial Embolization in Patients with Hemoptysis: Comparison of Angiographic Findings and Relapsing Period

PURPOSE: To describe the angiographic findings of patients with recurrent hemoptysis after bronchial artery embolization (BAE) according to the point at which relapse occurred. MATERIALS AND METHODS: From 125 patients who underwent BAE due to hemoptysis between 1996 and 2000, we selected 18 of 23 who underwent additional BAE due to recurrent bleeding after initial BAE . Depending on the point at which relapse occurred, they were divided into two groups (I and II, according to whether additional BAE was performed within two weeks of initial BAE or more than two weeks after this). We retrospectively compared the two groups in terms of angiographic findings, number of embolized arteries, and character of feeding arteries at initial and additional BAE. RESULTS: Nine patients in group I (additional BAE: n=10) and nine in group II (additional BAE: n=13) were admitted for recurrent hemoptysis within two weeks of initial BAE and more than two weeks after this, respectively. In group I(n=29) and II(n=31), angiography demonstrated two direct and 27 indirect, and two direct and 29 indirect signs of hemorrhage, respectively. No statistically significant differences were observed (x2=0.005, p=0.945). Among the embolized feeder ressels in group I (n=30) there were 20 bronchial artery and 10 non bronchial systemic collaterals, while for group II(n=35), the corresponding totals were 21 and 14. Again, no statistically significant differences were encountered(x2=0.308; p=0.579). In group I, feeders were newly developed in one case(10%), previously embolized in five(50%), and missed in four(40%), while in group two the corresponding figures were none, twelve(92.3%), and one(7.7%). No significant differences were noted, though the incidence of previously embolized feeders in Group II was very high (x2=5.383, p=0.068). CONCLUSION: Among patients in whom hemoptysis after BAE recurred at different times, the angiographic findings and number of embolized arteries were not significantly different, but differences in the nature of the feeder were noted. Patients in whom hemoptysis recurred more than two weeks after BAE showed more recanalization of previously embolized feeders than those in whom there was recurrence within two weeks.

The Arterial Embolization with Glue-Lipiodol Mixture in Patients with Hemoptysis

PURPOSE: To evaluate the efficacy of bronchial and intercostal arterial embolization using a glue-lipiodol mixture in patients with hemoptysis. MATERIALS AND METHODS: Between October 1997 and June 1999, 24 patients underwent 30 sessions of bronchial and intercostal arterial embolization using a glue-lipiodol mixture. The cause of hemoptysis was tuberculosis (n=11), bronchiectasis (n=9) or aspergilloma (n=4). Particular attention was paid to the source of bleeding, type and rate of complication and rate of recurrence, and the cause of recurrence and the duration of the asymptomatic period after bronchial and intercostal arterial embolization in patients with recurrent hemoptysis were also analysed. In addition, the asymptomatic period after bronchial and intercostal arterial emboilzation was classified as 24 hours or less, 7 days or less, or 6months or less. RESULTS: In all 24 cases, hemoptysis ceased immediately after bronchial and intercostal arterial embolization. In 18 cases, the focus of bleeding was a bronchial artery arising from the aorta, and in three of these cases there was also intercostal artery bleeding. In the remaining cases, the focus of bleeding was the right bronchial artery arising from the bronchointercostal trunk (n=5), or the intercostal artery only (n=1). During six of 24 sessions (25%) hemoptysis recurred within six months, but there was no recurrence within 24 hours or 7 days. The causes of recurrence were bleeding from systemic collaterals (n=5) and from another nonembolized bronchial artery (n=1). Retrosternal burning sensation (n=13; 43%) and shoulder pain (n=2; 7%) were detected but no complications critical. CONCLUSION: Because it involves non-recanalization of embolized vessels, bronchial and intereostol arterial embolization with a glue-lipiodol mixture can effectively control hemoptysis.

Coronary to Bronchial Artery Communication

PURPOSE: To analyze the cineangiographic appearance and determine the clinical importance of coronary-to-bronchial artery communication. MATERIALS AND METHODS: The coronary cineangiograms of 4,620 patients were reviewed, and 12 cases of coronary-to-bronchial artery communications were observed in 10 patients (M:F=6:4; mean age, 48.4 years). The cineangiographic findings were analyzed and correlated with these of other imaging studies [perfusion scan (n=5), computed tomographic angiography (CTA) (n=4), conventional chest computed tomography (CT) (n=1), and conventional angiography (n=6)]. RESULT: Cineangiography revealed that hypertrophied branches of the coronary artery communicated with bronchial arteries in which adjacent hypervascular staining, was observed, and which were accompanied by pulmonary shunts (n=9). The underlying diseases identified among the ten patients were Takayasu arteritis (n=5), chronic inflammatory pulmonary disease (n=3), pulmonary thromboembolism (n=1), and or newly diagnosed pulmonary tuberculosis (n=1). The lung fields supplied by coronary-to-bronchial communication showed close correlation with the territories of perfusion defects, decreased pulmonary vascularity, or inflammatory lesions revealed by other imaging studies. CONCLUSION: Coronary-to-bronchial artery communication can present as a secondary result of occlusive disease of the pulmonary arteries or chronic pulmonary inflammation, and in patients with hemoptysis involving, for example, incomplete embolization or myocardiac infarction, it may be problematic.

A Case Report of Aberrant Bronchial Artery from Common Carotid Artery: A Potential Hazard in Bronchial Artery Embolization

Embolization of the bronchial artery is a well-established treatment for patients with hemoptysis. To our know ledge, a case involving an aberrant bronchial artery from the common carotid artery has never been reported. The authors describe a case in which an aberrant bronchial artery from the left common carotid artery was a potential hazard during embolization of the bronchial artery.

Inferior phrenic arteries supply to the pulmonary hemorrhagic lesions:angiographic identification and interventional management / 中华放射学杂志

Objective To describe the manifestations of the inferior phrenic arteries(IPA)supply to the pulmonary hemorrhagic lesions and to evaluate the safety and efficacy of transcatheter arterial embolization(TAE)of the IPA.Methods The clinical data and imaging findings of eighteen patients with the additional blood supply to the pulmonary hemorrhagic lesions from the IPA were evaluated retrospectively.The causes of the bleeding were lung malignancies in 9,bronchiectasis in 7,and chronic inflammation in 2 patients.TAE supplementally was performed in patients with IPA supply to the pulmonary lesions,using polyvinyl alcohol particles,gelatin sponge particles,and microcoils.Results Selective arteriogram demonstrates an enlarged IPA,with numerous branches and hypervascularity in all 18 cases, with tumor staining in 9,the contrast material extravasation in 6,and non-specific staining in 2 cases.In addition,IPA-to-pulmonary shunting was found in 9 cases.All the lesions supplying by IPA were adjacent to the pleurae,including adjacent to the diaphragmatic pleura in 11,the mediastinal pleura in 5,and the lateral pleura of the lower lobe in 2 cases.Technical success of IPA embolization was achieved in the 18 cases.Embolization of other nonbronchial systemic arteries(the internal thoracic artery in 7 and intercostal artery in 3)was performed at the same session.All bleeding ceased immediately after supplemental IPA embolization.Follow-up time ranged from 8 months to 4 years.Mild recurrent hemoptysis occurred in 3 patients at 1,2,6 months respectively,after the embolization.These patients were responsive to conservative management.Recurrent bleeding did not occur in 15 patients during the follow-up. Conclusion The pulmonary hemorrhagic lesions,especially adjacent to the diaphragmatic and mediastinal pleurae,can be supplied by IPA,and may result in clinical failure following BAE.Supplemental TAE of IPA is a safe and effective adjunct to BAE in the management of bronchial bleeding supplied by IPA.

Bronchial Arterial Embolization for Hemoptysis: Analysis of Outcome in Various Underlying Causes

PURPOSE: To clarify the short-term effect and long-term results of bronchial arterial embolization forhemoptysis in three groups with tuberculosis, idiopathic bronchiectasis and lung cancer. MATERIALS AND METHODS:This study invo l ved 54 patients who underwent arterial embolization for the control of hemoptysis. Among 54, thecauses of hemorrhage were; pulmonary tuberculosis(n=32), idiopathic bronchiectasis (n=15), and lung cancer(n=7).In all patients, em-bolization was performed using Gelfoam particles and three underwent additional coilemboliza-tion. After the procedure, patients were followed up for between 1 and 95 (mean, 36.7) months. Short-termresults were assessed on the basis of careful observation of patients for 1 month after ar-terial embolization andwere classified as either; successful, indicating complete cessation of he-moptysis for 1 month, or failed,indicating continuing hemoptysis or recurrence within 1 month. Long-term results were evaluated in patients inwhom the procedure was successful in the short term and who could be followed up for at least 6 months. Patientsshowed either complete remis-sion(CR), indicating complete cessation of bleeding during the observation period;partial remis-sion(PR), indicating complete cessation of hemoptysis with recurrent bloody sputum during theobservation period; or recurrence, indicating recurrent hemoptysis, and were grouped accordingly. RESULTS: Noserious procedure related complications occurred except for mild chest pain or fever, of which showed spontaneousrelief within a few day s. The overall short-term success rate was 7 9 .6 %(43/54); individual rates were 84.4%for pulmonary tuberculosis (27/32), 80% for idiopathic bronchiectasis (10/15), and 57.1 % for lung cancer (4/7).Long-term follow-up showed that complete remission was achieved in 24 of 43 cases (55.8 %).The respectivelong-term remission and recur-rence rates were 75 % and 25 % for bronchiectasis, 70.4 % and 29.6 % for pulmonarytuberculosis. While four lung cancer patients whose initial outcome was successful showed no recurrence ofhe-moptysis, three died within 3 months of embolization. CONCLUSION: Embolization of bronchial arteries using aGelfoam sponge is effective as initial treat-ment for moderate or severe hemoptysis caused by benign disease.During long-term follow up, high remission rates were achieved in pulmonary tuberculosis and idiopathicbronchiectasis pa-tients, while the shortest bleeding control was in cases involving lung malignancy.

Transcatheter Arterial Embolization for Control of Hemoptysis in Pulmonary Tuberculosis: Analysis of Prognostic Factors

PURPOSE: To evaluate the effectiveness of transcatheter arterial embolization(TAE) and the relationshipbetween therapeutic effect and prognostic factors after this procedure. MATERIALS AND METHODS: Fifty-fivepatients with hemoptysis caused by pulmonary tuberculosis(TB) underwent TAE. We reviewed medical records of thehistory and activity of pulmonary TB, and the extent of treatment, and assessed plain chest PA for the extent oflesions ; we also evaluated the angiographic findings of embolized arteries, and embolic agents. The initialsuccess rate, as shown by immediate response, and recurrence during follow-up, were then observed. Using theChi-square test, differences in these findings were analysed. RESULTS: Immediate control of hemoptysis wasachieved in 46 of 55 patients(84%); 24 of 46(52.2%), experienced recurrence. Initial failure and partial responserates were higher in patients with active pulmonary TB(p<0.05) than in those in whom the condition was inactive.The recurrence rate was higher among those who had had pulmonary TB for between one and ten years (p<0.05). Therewas, however, no significant correlation between therapeutic effect and the extent of anti-TB treatment, theextent of lesions seen on plain chest PA, angiographic findings, embolized arteries, and embolic agents. CONCLUSION: The initial success rate of TAE was 84% and the recurrence rate was as high as 52.2%. Both activityand duration of pulmonary TB were prognostic factors in immediate response and recurrence.

Arterial Embolization for Management of Hemoptysis in Pulmonary Tuberculosis: Factors of Rebleeding

PURPOSE: To evaluate the effectiveness of arterial embolization in reducing hemoptysis in pulmonary tuberculosis, and rebleeding factors after embolization. MATERIALS AND METHODS: Fifty-nine patients with massiveor recurrent hemoptysis from pulmonary tuberculosis were underwent percutaneous transcatheter embolotherapy and thirteen were subsequentyly operated on. In 46 patients, we retrospectively analyzed on plain chest PA the extent of pulmonary tuberculosis lesions, the period from initial diagnosis to embolization, and angiographic findings. the extent of lesions shown on plain chest PA were classified into minimal, moderately advanced, and far advanced. If there was no evidence of rebleeding after the first embolization, this was regarded as initial success in thecontrol of hemoptysis. Angiographic findings were classified into hypervascularity, shunt, aneurysmal dilatation,and extravasation. Using the chi-square test, differences in these findings between rebleeding and non-rebleeding cases were analysed. RESULTS: Immediate control of hemoptysis was achieved in 27 (58.7%) of 46 patients. Hemoptysis recurred in 19 (41.3%) of 46 patients followed up. Rebleeding cases showed more nonbronchial systemiccollateral vessels and shunt than non-rebleeding cases (p<0.05). More advanced lesions of pulmonary tuberculosison plain chest PA showed an increased rebleeding rate after embolization, but this was not statistically significant There was no correlation between the period from initial diabnosis of pulmonary tuberculosis to embolization and the rate of rebleeding. But the longer the period, the greater the number of nonbronchial systemic collateral vessels. CONCLUSION: In cases with more advanced lesions of pulmonary tuberculosis on plainchest PA and a long period from initial diagnosis of pulmonary tuberculosis to embolization, angiographic findings showed numerous nonbronchial systemic collateral vessels but increases in the rebleeding rate were statistically not significant. The greater the number of nonbronchial systemic collateral vessels and shunt, the higher there bleeding rate after embolization.