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Bronchial artery embolization (BAE) is an emergency lifesaving procedure performed for submassive to massive hemoptysis. SE Asia has a high tuberculosis prevalence and many patients present with sub massive to massive hemoptysis. Given the inconsistent procedural success, unawareness about the procedure, lack of technical expertise and resources, the procedure is not commonly performed.
We analyzed consecutive patients that underwent BAE in our institution between January 2016 and January 2017.The patients were admitted to the Respiratory Intensive Care unit in our institution and met criteria for the procedure after a multi-disciplinary consensus that included the critical care physician,respiratory specialist and the interventional physician performing the procedure.Patients were subject to the routine blood work,chest X-ray, and CT scan prior to the procedure.When possible,a bronchoscopy was performed prior to the procedure to help localize the location of hemoptysis. Procedural success was defined by successful embolization of all culprit vessels and collaterals to the area.Clinical success was defined by successful cessation of hemoptysis.
In a 12 month period,BAE was performed in 29 patients. Average follow up was available for 6 +/- 5 months. 5F Simmons, Cobra or Judkins-Right catheters were most commonly used to engage the culprit vessels.The most common etiology for hemoptysis was Tuberculosis(65%) followed by Bronchiectasis(13.7%) and Aspergilloma(13.7%).A total of 78 vessels were embolized with a >95% procedural and clinical success.80%(23/29)of patients were discharged home. Pertinent interventional details of the study are presented in the table.
|Average vessels treated per patient||2.69|
|Total number of vessels treated||78|
|Systemic collaterals (Subclavian and non subclavian)||19|
|PVA Particles(300 micrometer) for embolization (Cook Medical, Bloomington, IN)||89%(70 vessels)|
|Microcoils for embolization (Cook Medical, Bloomington, IN)||11%(8 vessels)|
|Recurrence of Hemoptysis||1/29 (3.5%)|
|Procedure related major compliction||0%|
In patients with submassive to massive hemoptysis, BAE is a safe and effective procedure with a very high procedural success. For best results, embolization of all vessels to the area should be aggressively performed.
ENDOVASCULAR: Peripheral Vascular Disease and Intervention