COVID-19 Outbreak: Infection Control and Management Protocol for Vascular and Interventional Radiology Departments-Consensus Document.

COVID-19 (SARS-CoV-2 virus) pandemic was recently declared by the WHO as a global health emergency. A group of interventional radiology senior experts developed a consensus document for infection control and management of patients with COVID-19 in interventional radiology (IR) departments. This consensus statement has been brought together at short notice with the help of different protocols developed by governmental entities and scientific societies to be adapted to the current reality and needs of IR Departments. Recommendations are the specific strategies to follow in IR departments, preventive measures and regulations, step by step for donning and doffing personal protective equipment, specific IR procedures which can not be delayed, and aerosol-generating procedures in IR with COVID-19 patients. It is advisable with this document to be adapted to local workplace policies.

Factores predictores de recanalización arterial en pacientes con hemoptisis amenazante que requieren embolización arterial / Predictors of Recanalization in Patients With Life-Threatening Hemoptysis Requiring Artery Embolization

Introducción: La embolización arterial (EA) es útil en el tratamiento de la hemoptisis amenazante. El objetivo de este trabajo es describir la experiencia de un centro universitario terciario con la EA como tratamiento de la hemoptisis amenazante, caracterizar los hallazgos angiográficos cuando hay recidivas, y analizar los factores asociados con estos hallazgos. Material y métodos: Estudio observacional retrospectivo en el que se incluyeron todos los pacientes con una EA debido a hemoptisis amenazante durante un periodo de 13 años. Los efectos de: a) tiempo hasta recurrencia; b) uso de coils, y c) número de arterias embolizadas sobre la probabilidad que el sangrado tuviera el mismo origen vascular que en el episodio previo fueron analizados. Resultados: Se incluyeron 176 pacientes en el estudio. Murieron por hemoptisis 22 pacientes (12,5%). La probabilidad de sobrevivir libre de recidiva al mes fue de 0,91 (IC 95%: 0,87 a 0,95), a los 12 meses de 0,85 (IC 95%: 0,79 a 0,91) y a los 3 años de 0,75 (IC 95%: 0,66 a 0,83). La probabilidad de que la recurrencia fuera debida a una afectación de la misma arteria dependía del tiempo hasta la recurrencia (estimado = 0,0157, valor de z = 2,41, valor de p = 0,016). Conclusión: La EA es efectiva en el tratamiento de la hemoptisis, pero las recidivas no son infrecuentes. La recidiva del sangrado por recanalización de la arteria embolizada está relacionada con el tiempo transcurrido hasta la recidiva, pero no con el uso de coils ni con el número de arterias embolizadas

Introduction: Artery embolization (AE) is a safe and useful procedure in the management of massive hemoptysis. The objective of our study was to describe the experience of AE in a tertiary referral center, to characterize angiographic findings at the time of recurrence, and to analyze factors associated with these findings. Material and methods: Observational retrospective study of patients presenting with life-threatening hemoptysis. All consecutive patients with at least one episode of hemoptysis that required AE during a 13-year period were included. The effects of I) time to recurrence; II) use of coils, and III) number of arteries embolized on the likelihood that the recurrence was secondary to recanalization were assessed. Results: One hundred seventy-six patients were included in the study. Twenty-two patients (12.5%) died due to hemoptysis. Probability of recurrence-free survival at one month was 0.91 (95% CI: 0.87 to 0.95), at 12 months was 0.85 (95% CI: 0.79 to 0.91), and after 3 years was 0.75 (95% CI: 0.66 to 0.83). A longer time to recurrence was associated with a higher probability that the hemorrhage affected the same artery (estimate = 0.0157, z-value = 2.41, p-value = 0.016). Conclusion: AE is a safe and useful technique in the management of massive and recurrent hemoptysis. Nevertheless, recurrence after embolization is not uncommon. Recurring hemoptysis due to recanalization is related to time to recurrence, but not to the use of coils or number of arteries embolized

Results of bronchial artery embolization for the treatment of hemoptysis caused by neoplasm.

PURPOSE: To describe experience with bronchial artery embolization (BAE) in a cohort of patients with cancer. MATERIALS AND METHODS: All consecutive patients with cancer and at least one episode of hemoptysis that required BAE during a 14-year period were included in this observational retrospective review. The endpoints of the study were immediate success, recurrence of hemoptysis, mortality resulting from hemoptysis, and all-cause mortality. RESULTS: Immediate control of bleeding was achieved in 31 of 40 patients (77.5%). Recurrence requiring BAE occurred in eight patients (20%). Cumulative hemoptysis control rate was 0.90 (95% confidence interval [CI], 0.80-1.0) at 1 month and 0.65 (95% CI, 0.44-0.86) at 6 months. Probability of survival was 0.75 (95% CI, 0.62-0.88) at 1 month, 0.42 (95% CI, 0.27-0.57) at 6 months, 0.36 (95% CI, 0.21-0.51) at 12 months, and 0.08 (95% CI, 0.0-0.18) at 3 years. CONCLUSIONS: BAE is an effective and safe technique in the treatment of hemoptysis in patients with cancer. Nevertheless, mortality resulting from hemoptysis and recurrence rate are high among these patients secondary to progression of the underlying disease.

Treatment of a complicated penetrating ulcer of the descending thoracic aorta using a scalloped stent graft.

We show the use of a proximal scalloped stent graft for an pseudoaneurysm of the descending thoracic aorta to avoid occlusion of the left subclavian artery. A 63-year-old man with sudden onset dysphonia was diagnosed with left vocal fold paralysis and the presence of a lung mass. A computed tomography scan revealed saccular dilatation of the aortic arch (proximal neck: <10 mm) with suggestive images of a penetrating ulcer and degenerative pseudoaneurysm. A RELAY Plus thoracic stent graft (Bolton Medical, Sunrise, FL) with proximal scallop was implanted to preserve the left subclavian artery. A custom made prosthesis with proximal scallop provides a good alternative to a carotid-subclavian bypass because it is less aggressive and can be used in nonurgent cases.

Predictors of recanalization in patients with life-threatening hemoptysis requiring artery embolization.

INTRODUCTION: Artery embolization (AE) is a safe and useful procedure in the management of massive hemoptysis. The objective of our study was to describe the experience of AE in a tertiary referral center, to characterize angiographic findings at the time of recurrence, and to analyze factors associated with these findings. MATERIAL AND METHODS: Observational retrospective study of patients presenting with life-threatening hemoptysis. All consecutive patients with at least one episode of hemoptysis that required AE during a 13-year period were included. The effects of i)time to recurrence; ii)use of coils, and iii)number of arteries embolized on the likelihood that the recurrence was secondary to recanalization were assessed. RESULTS: One hundred seventy-six patients were included in the study. Twenty-two patients (12.5%) died due to hemoptysis. Probability of recurrence-free survival at one month was 0.91 (95%CI: 0.87 to 0.95), at 12months was 0.85 (95%CI: 0.79 to 0.91), and after 3 years was 0.75 (95%CI: 0.66 to 0.83). A longer time to recurrence was associated with a higher probability that the hemorrhage affected the same artery (estimate=0.0157, z-value=2.41, p-value=0.016). CONCLUSION: AE is a safe and useful technique in the management of massive and recurrent hemoptysis. Nevertheless, recurrence after embolization is not uncommon. Recurring hemoptysis due to recanalization is related to time to recurrence, but not to the use of coils or number of arteries embolized.

Temporal patterns in severe hemoptysis requiring bronchial artery embolization.

BACKGROUND: Although some authors have suggested that there is some seasonal periodicity in hemoptysis, temporal patterns of hemoptysis have been poorly investigated. The aim of this study is to describe the temporal pattern of severe hemoptysis which required bronchial artery embolization (BAE). METHODS: All consecutive patients with at least one episode of hemoptysis which required BAE during a 13-year period were included. Recurring hemoptysis requiring BAE in a patient with previous embolization was included as a new hemoptysis event, unless it occurred within one month from the prior event. Lineal regression was applied to compute the tendency of occurrence of cases along 13 years of record data. The daily and monthly distributions of embolizations were used to study the weekly and monthly seasonal indexes. RESULTS: Hemoptysis requiring BAE occurred with some monthly variation demonstrated with two monthly peaks, with the first one occurring during April and the second one during November. CONCLUSION: Hemoptysis occurred with two monthly peaks. This seasonal trend might be due to different prevalence of respiratory tract infections or to some weather variables. Identification of significant environmental factors could be useful to improve preventive measures.