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American Family Physician Feb 2022Hemoptysis is the expectoration of blood from the lower respiratory tract, usually from bronchial arteries. The most common causes are acute respiratory infections,...
Hemoptysis is the expectoration of blood from the lower respiratory tract, usually from bronchial arteries. The most common causes are acute respiratory infections, cancer, bronchiectasis, and chronic obstructive pulmonary disease. No cause is identified in 20% to 50% of cases. Hemoptysis must be differentiated from pseudohemoptysis, which is blood that originates from nasopharyngeal or gastrointestinal sources. The initial evaluation includes determining the severity of bleeding and stability of the patient and may require bronchoscopy for airway protection. Mild hemoptysis comprises more than 90% of cases and has a good prognosis, whereas massive hemoptysis has a high mortality rate. A history and physical examination can assist in identifying an etiology, but diagnostic testing is often required. Chest radiography is a good initial test, but it has limited sensitivity for determining the site and etiology of the bleeding. Computed tomography and computed tomography angiography of the chest with intravenous contrast are the preferred modalities to determine the etiology of bleeding; however, bronchoscopy may also be needed. In addition to supportive medical treatment, management should include treatment of the underlying etiology because recurrence often takes place in the absence of treatment of the identified cause. Bronchial arterial embolization is used to treat massive hemoptysis, particularly when an involved artery is noted on computed tomography angiography. Surgery is reserved for patients whose medical treatment and embolization are not effective.
Topics: Angiography; Bronchial Arteries; Bronchoscopy; Embolization, Therapeutic; Hemoptysis; Humans
PubMed: 35166503
DOI: No ID Found -
JAMA Surgery Dec 2020Splenic arterial embolization (SAE) improves the rate of spleen rescue, yet the advantage of prophylactic SAE (pSAE) compared with surveillance and then embolization... (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Splenic arterial embolization (SAE) improves the rate of spleen rescue, yet the advantage of prophylactic SAE (pSAE) compared with surveillance and then embolization only if necessary (SURV) for patients at high risk of spleen rupture remains controversial.
OBJECTIVE
To determine whether the 1-month spleen salvage rate is better after pSAE or SURV.
DESIGN, SETTING, AND PARTICIPANTS
In this randomized clinical trial conducted between February 6, 2014, and September 1, 2017, at 16 institutions in France, 133 patients with splenic trauma at high risk of rupture were randomized to undergo pSAE or SURV. All analyses were performed on a per-protocol basis, as well as an intention-to-treat analysis for specific events.
INTERVENTIONS
Prophylactic SAE, preferably using an arterial approach via the femoral artery, or SURV.
MAIN OUTCOMES AND MEASURES
The primary end point was an intact spleen or a spleen with at least 50% vascularized parenchyma detected on an arterial computed tomography scan at 1 month after trauma, assessed by senior radiologists masked to the treatment group. Secondary end points included splenectomy and pseudoaneurysm, secondary SAE after inclusion, complications, length of hospital stay, quality-of-life score, and length of time off work or studies during the 6-month follow-up.
RESULTS
A total of 140 patients were randomized, and 133 (105 men [78.9%]; median age, 30 years [interquartile range, 23-47 years]) were retained in the study. For the primary end point, data from 117 patients (57 who underwent pSAE and 60 who underwent SURV) could be analyzed. The number of patients with at least a 50% viable spleen detected on a computed tomography scan at month 1 was not significantly different between the pSAE and SURV groups (56 of 57 [98.2%] vs 56 of 60 [93.3%]; difference, 4.9%; 95% CI, -2.4% to 12.1%; P = .37). By the day 5 visit, there were significantly fewer splenic pseudoaneurysms among patients in the pSAE group than in the SURV group (1 of 65 [1.5%] vs 8 of 65 [12.3%]; difference, -10.8%; 95% CI, -19.3% to -2.1%; P = .03), significantly fewer secondary embolizations among patients in the pSAE group than in the SURV group (1 of 65 [1.5%] vs 19 of 65 [29.2%]; difference, -27.7%; 95% CI, -41.0% to -15.9%; P < .001), and no difference in the overall complication rate between the pSAE and SURV groups (19 of 65 [29.2%] vs 27 of 65 [41.5%]; difference, -12.3%; 95% CI, -28.3% to 4.4%; P = .14). Between the day 5 and month 1 visits, the overall complication rate was not significantly different between the pSAE and SURV groups (11 of 59 [18.6%] vs 12 of 63 [19.0%]; difference, -0.4%; 95% CI, -14.4% to 13.6%; P = .96). The median length of hospitalization was significantly shorter for patients in the pSAE group than for those in the SURV group (9 days [interquartile range, 6-14 days] vs 13 days [interquartile range, 9-17 days]; P = .002).
CONCLUSIONS AND RELEVANCE
Among patients with splenic trauma at high risk of rupture, the 1-month spleen salvage rate was not statistically different between patients undergoing pSAE compared with those receiving SURV. In view of the high proportion of patients in the SURV group needing SAE, both strategies appear defendable.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT02021396.
Topics: Adult; Aneurysm, False; Embolization, Therapeutic; Female; Humans; Length of Stay; Male; Middle Aged; Prospective Studies; Return to Work; Spleen; Splenectomy; Splenic Artery; Splenic Rupture; Time Factors; Tomography, X-Ray Computed; Watchful Waiting; Wounds, Nonpenetrating; Young Adult
PubMed: 32936242
DOI: 10.1001/jamasurg.2020.3672 -
Respirology (Carlton, Vic.) Aug 2022Interventional radiology (IR) is a rapidly expanding medical subspecialty and refers to a range of image-guided procedural techniques. The image guidance allows... (Review)
Review
Interventional radiology (IR) is a rapidly expanding medical subspecialty and refers to a range of image-guided procedural techniques. The image guidance allows real-time visualization and precision placement of a needle, catheter, wire and device to deep body structures through small incisions. Advantages include reduced risks, faster recovery and shorter hospital stays, lower costs and less patient discomfort. The range of chest interventional procedures keeps on expanding due to improved imaging facilities, better percutaneous assess devices and advancing ablation and embolization techniques. These advances permit procedures to be undertaken safely, simultaneously and effectively, hence escalating the role of IR in the treatment of chest disorders. This review article aims to cover the latest developments in some image-guided techniques of the chest, including thermal ablation therapy of lung malignancy, targeted therapy of pulmonary embolism, angioplasty and stenting of mediastinal venous/superior vena cava occlusion, pulmonary arteriovenous malformation treatment and bronchial artery embolization for haemoptysis.
Topics: Arteriovenous Fistula; Embolization, Therapeutic; Humans; Pulmonary Artery; Stents; Vena Cava, Superior
PubMed: 35758539
DOI: 10.1111/resp.14315 -
Japanese Journal of Clinical Oncology May 2021Previous reports on transarterial treatment for lung cancer were reviewed. The bronchial arterial infusion therapy has a long history since 1964. Better local control... (Review)
Review
Previous reports on transarterial treatment for lung cancer were reviewed. The bronchial arterial infusion therapy has a long history since 1964. Better local control with less doses of anti-neoplastic agents was warranted by trying transarterial administration to lung and mediastinal tumors. It is reported that both primary and metastatic tumors are fed by bronchial or other systemic arteries. The bronchial arterial embolization for hemoptysis has been introduced for clinical practice since 1973. Hemoptysis by not only benign but also malignant diseases has been well controlled by embolization. In recent decades, the technical elements for transarterial treatments have markedly improved. They make it possible to carry out precise procedures of selective catheter insertion to the tumor relating arteries. Current concepts of transarterial treatment, technical aspects and treatment outcomes are summarized. Tentative result from chemo-embolization for advanced lung cancer using recent catheter techniques was also described. It provides favorable local control and survival merits. It is considered that a population of lung cancer patients can benefit from transarterial management using small doses of anti-neoplastic agents, with less complications and less medical costs.
Topics: Bronchial Arteries; Catheterization, Peripheral; Disease Progression; Embolization, Therapeutic; Hemoptysis; Humans; Lung; Lung Neoplasms; Treatment Outcome
PubMed: 33855367
DOI: 10.1093/jjco/hyab050 -
European Urology Jul 2021Prostatic artery embolisation (PAE) for the treatment of lower urinary tract symptoms secondary to benign prostatic obstruction (LUTS/BPO) still remains under... (Randomized Controlled Trial)
Randomized Controlled Trial
Prostatic Artery Embolisation Versus Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia: 2-yr Outcomes of a Randomised, Open-label, Single-centre Trial.
BACKGROUND
Prostatic artery embolisation (PAE) for the treatment of lower urinary tract symptoms secondary to benign prostatic obstruction (LUTS/BPO) still remains under investigation.
OBJECTIVE
To compare the efficacy and safety of PAE and transurethral resection of the prostate (TURP) in the treatment of LUTS/BPO at 2 yr of follow-up.
DESIGN, SETTING, AND PARTICIPANTS
A randomised, open-label trial was conducted. There were 103 participants aged ≥40 yr with refractory LUTS/BPO.
INTERVENTION
PAE versus TURP.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
International Prostate Symptoms Score (IPSS) and other questionnaires, functional measures, prostate volume, and adverse events were evaluated. Changes from baseline to 2 yr were tested for differences between the two interventions with standard two-sided tests.
RESULTS AND LIMITATIONS
The mean reduction in IPSS after 2 yr was 9.21 points after PAE and 12.09 points after TURP (difference of 2.88 [95% confidence interval 0.04-5.72]; p = 0.047). Superiority of TURP was also found for most other patient-reported outcomes except for erectile function. PAE was less effective than TURP regarding the improvement of maximum urinary flow rate (3.9 vs 10.23 ml/s, difference of -6.33 [-10.12 to -2.54]; p < 0.001), reduction of postvoid residual urine (62.1 vs 204.0 ml; 141.91 [43.31-240.51]; p = 0.005), and reduction of prostate volume (10.66 vs 30.20 ml; 19.54 [7.70-31.38]; p = 0.005). Adverse events were less frequent after PAE than after TURP (total occurrence n = 43 vs 78, p = 0.005), but the distribution among severity classes was similar. Ten patients (21%) who initially underwent PAE required TURP within 2 yr due to unsatisfying clinical outcomes, which prevented further assessment of their outcomes and, therefore, represents a limitation of the study.
CONCLUSIONS
Inferior improvements in LUTS/BPO and a relevant re-treatment rate are found 2 yr after PAE compared with TURP. PAE is associated with fewer complications than TURP. The disadvantages of PAE regarding functional outcomes should be considered for patient selection and counselling.
PATIENT SUMMARY
Prostatic artery embolisation is safe and effective. However, compared with transurethral resection of the prostate, its disadvantages regarding subjective and objective outcomes should be considered for individual treatment choices.
Topics: Arteries; Embolization, Therapeutic; Humans; Lower Urinary Tract Symptoms; Male; Prostate; Prostatic Hyperplasia; Transurethral Resection of Prostate; Treatment Outcome
PubMed: 33612376
DOI: 10.1016/j.eururo.2021.02.008 -
Techniques in Vascular and... Mar 2020The prevalence of obesity is increasing globally, leading to significantly increased morbidity, mortality, and health care costs. However, there is a lack of effective... (Review)
Review
The prevalence of obesity is increasing globally, leading to significantly increased morbidity, mortality, and health care costs. However, there is a lack of effective treatment options that can treat patients with obesity less invasively than with bariatric surgery. Bariatric arterial embolization (BAE) is an image-guided, minimally invasive, percutaneous procedure that is currently being investigated in preclinical animal models and early clinical trials. If successful, BAE may represent a viable interventional approach for obesity treatment. The purpose of this article is to introduce the physiological and anatomical rationale for BAE, review techniques involved in performing BAE for weight modulation, and provide up-to-date preclinical evidence that supports the translation of BAE into patients.
Topics: Animals; Appetite Regulation; Embolization, Therapeutic; Feeding Behavior; Gastric Artery; Gastric Fundus; Ghrelin; Humans; Obesity; Signal Transduction; Translational Research, Biomedical; Treatment Outcome; Weight Loss
PubMed: 32192641
DOI: 10.1016/j.tvir.2020.100656 -
Radiologia 2020To present our results and describe the technique used for the endovascular treatment of hemorrhoids. (Observational Study)
Observational Study
OBJECTIVE
To present our results and describe the technique used for the endovascular treatment of hemorrhoids.
MATERIAL AND METHODS
We used right femoral artery or radial artery access to catheterize the inferior mesenteric artery, proceeding to the superior rectal artery with a 2.7F microcatheter to catheterize and embolize each distal branch distally with PVA particles (300-500μm) and proximally with coils (2-3mm). Patients were discharged 24hours after the procedure and clinically followed up at one month by anoscopy.
RESULTS
We included 20 patients (4 women and 16 men; mean age, 61.85 years (27-81 years); mean follow-up, 10.6 months (28-2 months). Technical success was achieved in 18 (90%) patients and clinical success in 15 (83.4%); one patient required a second embolization of the medial rectal artery and two required surgery. Recovery was practically painless. At the one-month follow-up, all patients were very satisfied and anoscopy demonstrated marked improvement of the hemorrhoids. There were no complications secondary to embolization.
CONCLUSIONS
Our initial results suggest that selective intra-arterial embolization is a safe and painless procedure that is well tolerated because it avoids rectal trauma and patients recover immediately.
Topics: Adult; Aged; Aged, 80 and over; Catheterization; Embolization, Therapeutic; Female; Femoral Artery; Hemorrhoids; Humans; Male; Mesenteric Artery, Inferior; Middle Aged; Radial Artery; Retrospective Studies
PubMed: 32029240
DOI: 10.1016/j.rx.2019.12.004 -
Respiratory Medicine Apr 2020Aspergilloma, also known as mycetoma or fungus ball, is the most common manifestation of pulmonary involvement by Aspergillus species. The fungal ball typically forms... (Review)
Review
Aspergilloma, also known as mycetoma or fungus ball, is the most common manifestation of pulmonary involvement by Aspergillus species. The fungal ball typically forms within preexisting cavities of the lungs. Diagnosis requires both radiographic evidence along with serologic or microbiologic evidence of Aspergillus species involvement. While clinical features such as hemoptysis, chest pain, shortness of breath, cough, and fever are helpful in diagnosis, they are non-specific symptoms. Surgery is currently the mainstay of treatment for aspergilloma but is associated with considerable mortality and morbidity. Alternative options exist for patients who are poor surgical candidates and for those who prefer a less invasive treatment modality. Systemic treatment with amphotericin B is ineffective and is not recommended as a monotherapy, but systemic azoles is effective in approximately 50-80% of patients. Potential alternatives to surgery include intracavitary instillation or endobronchial administration of antifungal medication, as well as direct transbronchial aspergilloma removal. Bronchial artery embolization and radiotherapy are options to manage hemoptysis until definite eradication of the aspergilloma. More rigorous studies are needed to better establish non-surgical treatment paradigm for inoperable patients.
Topics: Amphotericin B; Antifungal Agents; Azoles; Bronchial Arteries; Conservative Treatment; Embolization, Therapeutic; Female; Hemoptysis; Humans; Instillation, Drug; Male; Pulmonary Aspergillosis
PubMed: 32217289
DOI: 10.1016/j.rmed.2020.105903 -
AJNR. American Journal of Neuroradiology Aug 2022Skull base tumors are commonly supplied by dural branches of the meningohypophyseal and inferolateral trunks. Embolization through these arteries is often avoided due to...
BACKGROUND AND PURPOSE
Skull base tumors are commonly supplied by dural branches of the meningohypophyseal and inferolateral trunks. Embolization through these arteries is often avoided due to technical challenges and inherent risks; however, successful embolization can be a valuable surgical adjunct. We aimed to review the success and complications in our series of tumor embolizations through the meningohypophyseal and inferolateral trunks.
MATERIALS AND METHODS
We performed a retrospective review of patients with tumor treated with preoperative embolization at our institution between 2010 and 2020. We reviewed the following data: patients' demographics, tumor characteristics, endovascular embolization variables, and surgical results including estimated blood loss, the need for transfusion, and operative time.
RESULTS
Among 155 tumor embolization cases, we identified 14 patients in whom tumor embolization was performed using the meningohypophyseal ( = 13) or inferolateral ( = 4) trunk. In this group of patients, on average, 79% of tumors were embolized. No mortality or morbidity from the embolization procedure was observed in this subgroup of patients. The average estimated blood loss in the operation was 395 mL (range, 200-750 mL). None of the patients required a transfusion, and the average operative time was 7.3 hours.
CONCLUSIONS
Some skull base tumors necessitate embolization through ICA branches such as the meningohypophyseal and inferolateral trunks. Our series demonstrates that an effective and safe embolization may be performed through these routes.
Topics: Humans; Arteries; Embolization, Therapeutic; Preoperative Care; Retrospective Studies; Skull Base Neoplasms
PubMed: 35902121
DOI: 10.3174/ajnr.A7579 -
South African Medical Journal =... Feb 2023Rasmussen aneurysms are abnormalities of the pulmonary arterial system caused by tuberculosis (TB). They are associated with a highmortality rate when they cause...
Rasmussen aneurysms are abnormalities of the pulmonary arterial system caused by tuberculosis (TB). They are associated with a highmortality rate when they cause life-threatening haemoptysis. High TB-prevalence regions have a large burden of TB-related haemoptysisbut often limited resources. This series of 25 patients who presented with life-threatening haemoptysis from current and/or previous TBwere found to have abnormal pulmonary arteries on computed tomography pulmonary angiogram (CTPA), which were judged to belikely contributors to their bleeding, either in isolation or with concomitant abnormal bronchial or systemic vasculature. These patientsunderwent transcatheter placement of Amplatzer vascular plugs in the feeder pulmonary artery. Bronchial and systemic lesions wereaddressed separately as needed. Immediate technical success was achieved in all patients, but four of them experienced intraoperativehaemoptysis related to dislodgement of the occluding platelet plug by the high-pressure automatic injector and wire. At 48 hours after theprocedure, 18 (72%) remained haemoptysis-free. Six of these experienced recurrence within 1 year of their procedure. Pulmonary arteryplacement of an Amplatzer vascular plug is a feasible option for treating bleeding Rasmussen aneurysms, but should be part of a combinedapproach to addressing suspected culprit vascular lesions in all intrathoracic vascular systems.
Topics: Humans; Treatment Outcome; Embolization, Therapeutic; Retrospective Studies; South Africa; Hemoptysis; Aneurysm
PubMed: 36757074
DOI: 10.7196/SAMJ.2022.v113i2.16758