Transcatheter Bronchial Artery Embolization in the Multimodality Management of Massive Hemoptysis: Discussion (2)
Particles of absorbable gelatin sponge have been the most frequently used occluding medium. Transcatheter bronchial artery embolization requires precise localization and thus a relatively cooperative patient. As in this case, a bronchial occluder controlled the hemorrhage and permitted the urgent embolization to proceed with relative ease.
Recurrence of bleeding after successful TBAE is a problem in at least 20 percent of patients; it is particularly a problem for patients with aspergillosis who tend to develop extrapulmonary systemic collateral arteries. Other causes of recurrence include inadequate embolization, imprecise localization of initial bleeding, bronchial artery recanalization, and progression of underlying disease. buy ortho tri-cyclen online
In view of the high incidence of recurrent bleeding, TBAE should be considered a palliative approach, to be followed expeditiously by definitive surgical therapy whenever possible. However, for selected patients, including those who are poor operative risks, TBAE may be life-saving definitive therapy. In the case herein presented, surgery was not appropriate because of the history of malignancy, the location of the lesion, and the prior radiation therapy.