Clinical characteristics and postoperative outcomes of systemic artery-to-pulmonary vessel fistula in hemoptysis patients

Analysis of recurrence of risk factors after transcatheter bronchial artery embolization for hemoptysis

BACKGROUND

As a proven and preferred technique for hemoptysis, bronchial artery embolization (BAE) cannot avoid the possibility of postoperative recurrence; however, few studies have examined the causes of hemoptysis recurrence after BAE.

OBJECTIVES

Identify the risk factors for hemoptysis recurrence after BAE treatment.

DESIGN

Retrospective.

SETTING

Tertiary training and research hospital.

PATIENTS AND METHODS

A retrospective analysis was conducted on 406 patients with hemoptysis, 55 patients who developed with recurrent postembolization hemoptysis, covering the period from January 2011 to January 2021. Single factor analysis and multiple factor logistic regression were used to analyze high-risk factors for hemoptysis recurrence.

MAIN OUTCOME MEASURES

The incidence and risk factors for recurrence hemoptysis associated with transcatheter BAE.

SAMPLE SIZE

406 patients.

RESULTS

Multivariate logistic regression analysis showed that preoperative computed tomography angiography (CTA) (odds ratio [OR]: 0.052, 95% CI: 0.012-0.225), tumor-related hemoptysis (OR: 20.753, 95% CI: 6.778-63.545), pleural thickening (OR: 3.168, 95% CI: 1.081-9.286), and bilateral lung lesions (OR: 8.442, 95% CI: 2.449-29.101) had a statistically significant impact on the recurrence of hemoptysis after BAE.

CONCLUSIONS

Preoperative CTA serves as a protective factor against hemoptysis recurrence, whereas tumor-related hemoptysis, pleural thickening, and bilateral lung diseases are significant risk factors for hemoptysis recurrence following interventional therapy.

LIMITATIONS

This was a retrospective analysis of a single center with a small sample, which may have a certain degree of recall bias when collecting data, thus, reducing the reliability of the results.

Case Report: Ectopic pulmonary embolism as a complication of bronchial artery embolization

Bronchial artery embolization (BAE) is currently the first-line treatment for massive hemoptysis. Previous studies have proven its safety and efficacy, with mild, transient, and reversible complications. This case described a patient with congenital multiple bronchopulmonary fistulas who underwent BAE due to massive hemoptysis. However, due to an overlooked and misdiagnosed atypical fistula, the patient experienced an ectopic pulmonary embolism and subsequently secondary pulmonary infarction. He eventually exhibited a full postoperative recovery following percutaneous catheter-directed embolectomy. This case revealed a type of occult fistula masked by multiple bronchial artery branches, which may be a potential risk factor for an ectopic pulmonary embolism during BAE. We propose that it is crucial to identify abnormal anastomosis, especially atypical fistula, and select appropriate embolization materials during BAE.

Bronchial artery embolization versus conservative treatment for hemoptysis: a systematic review and meta-analysis

BACKGROUND

Bronchial artery embolization (BAE) is currently an important treatment for hemoptysis. However, there is no consensus in the efficacy and safety of BAE compared to conservative treatment for hemoptysis, which limits the widespread use of BAE in hemoptysis. The objective was to assess the clinical benefit of BAE versus conservative treatment in patients with hemoptysis.

METHODS

A systematic search was conducted on the PubMed, Embase, ScienceDirect, CochraneLibrary, and ClinicalTrials up to March 2023. Both randomized controlled trials (RCTs) and cohort studies reporting rates of recurrent hemoptysis, clinical success, mortality, and complication by BAE and conservative treatment alone for hemoptysis were included. Data were pooled and compared by the use of odds ratio (OR) and 95% confidence interval (CI).

RESULTS

Twelve studies (three RCTs, nine cohorts) involving 1231 patients met the eligibility criteria. Patients treated with BAE had lower recurrence rates of hemoptysis (26.5% vs. 34.6%; OR 0.37, 95% CI 0.14-0.98), higher clinical success rates (92.2% vs. 80.9%; OR 2.77, 95% CI 1.66-4.61), and lower hemoptysis-related mortality (0.8% vs. 3.2%; OR 0.20, 95% CI 0.05-0.84) compared with conservative treatment alone. There was no significant difference in all-cause mortality between the two groups. In terms of security, the incidence of major complications and minor complications in patients undergoing BAE treatment was 0.2% (1/422) and 15.6%, respectively.

CONCLUSIONS

BAE was more effective than conservative treatment alone in controlling hemoptysis, reducing recurrence, and decreasing hemoptysis-related mortality, with an almost negligible risk of major complications.

Successful Treatment of Multiple Systemic Artery-to-Pulmonary Artery Fistulas

Systemic artery-to-pulmonary artery fistula (SAPAF) is an uncommon abnormal vascular connection between systemic and pulmonary arteries. SAPAF with 3 or more inflow vessels has rarely been reported. The definitive diagnosis is made by selective arterial angiography, but 3-dimensional computed tomography angiography is useful for delineating abnormal vessels. Embolization is currently performed as a less invasive treatment option, but surgical treatment remains an essential treatment option for preventing recurrence, especially in cases with many abnormal vessels. Herein, we report a case of successful treatment of SAPAF by sparing the lung parenchyma through abnormal inflow vessel dissection and peripheral lung abnormal tissue resection.

FEASIBILITY STUDY OF LOW TUBE VOLTAGE COMPUTER TOMOGRAPHY ANGIOGRAPHY (CTA) FOR BRONCHIAL ARTERY IMAGING IN PATIENTS WITH HEMOPTYSIS

OBJECTIVE

To investigate the application of low tube voltage computer tomography angiography (CTA) in bronchial artery (BA) imaging in hemoptysis patients.

METHODS

Between January 2017 and December 2021, 119 patients were studied, including 31 in the 80-kV group, 39 in the 100-kV group and 49 in the control group (120 kV). The CT dose index-volume (CTDIvol) (mGy) and effective dose (ED) (mSv) of each group were comparatively analysed. Image quality evaluation included the signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and subjective 5-scores.

RESULTS

Statistically significant differences were noted in CTDIvol, ED, SNR, CNR and image quality scores of the groups (P < 0.05). Comparative analysis showed no statistical difference in CTDIvol, ED and image quality scores between the 80- and 100-kV groups.

CONCLUSION

Low tube voltage CTA is useful in BA imaging for hemoptysis patients. Tube voltages of 100 kV have better image quality and lower radiation dose.

Clinical outcomes of vinorelbine loading CalliSpheres beads in the treatment of previously treated advanced lung cancer with progressive refractory obstructive atelectasis

Background: Drug-eluting beads bronchial arterial chemoembolization (DEB-BACE) has been used in the treatment of locally advanced lung cancer and has the potential to improve outcomes and reduce recurrence. However, DEB-BACE shows a poor therapeutic effect in advanced lung cancer after failure of multiple therapies. This study assessed the effect of DEB-BACE in the treatment of progressive lung cancer with refractory obstructive atelectasis. Methods: Progressive advanced lung cancer patients with refractory obstructive atelectasis were voluntarily enrolled in this study after failure of multiple conventional therapies. Baseline information, DEB-BACE treatment process, and changes in clinical symptoms were recorded. The primary endpoints were the objective response rate (ORR) and improvement rate of dyspnea. The secondary endpoints were time-to-progression (TTP), overall survival (OS), and rate of pulmonary re-expansion. Treatment-related adverse events and serious adverse events were analyzed to assess the safety of DEB-BACE. The Cox regression model was performed to analyze the possible factors impacting prognosis of DEB-BACE. Results: DEB-BACE was successfully performed with CalliSpheres beads loaded with vinorelbine in the 20 enrolled patients. ORR and disease control rate were 80% and 85%, respectively, at the first follow-up (43.4 ± 15.26 days). The improvement rate of dyspnea was 85% and 80% at 1 week and 1 month (p < 0.0001, p < 0.0001), respectively. TTP was 41.25 ± 14.43 days and 89.55 ± 61.7 days before and after DEB-BACE, respectively; DEB-BACE delayed the progression of advanced lung cancer (p < 0.0001). OS was 238.03 ± 33.74 days (95% confidence interval: 171.9-304.16). The rate of pulmonary re-expansion was 80% at the first follow-up. The reasons for poor prognosis were tumor necrosis, longer disease duration, and pulmonary atelectasis duration (p = 0.012, p = 0.038, p = 0.029). Massive hemoptysis was observed in two cases, and one patient died of asphyxia caused by hemoptysis. Moderate hemoptysis occurred in one case. All three adverse events were considered as the result of the tumor cavity after DEB-BACE. Conclusion: DEB-BACE loaded with vinorelbine is a feasible option for progressive advanced lung cancer with obstructive atelectasis after failure of other treatments.