Chest-Wall Collateral Embolization to Reduce Surgical Blood Loss in Peripheral Aspergillomas

Abstract

Objectives The objective of this study was to present the procedural details and digital subtraction angiography (DSA) findings of perioperative chest-wall collateral embolization (PCCE) and compare intraoperative blood loss in patients of pulmonary aspergilloma (PA) undergoing lung resection with and without PCCE. Materials and Methods Since November 2017, we have performed PCCE in 17 patients (14 males, three females, age 34.41 ± 12.85 years) before surgery for PA (embolization group). Retrospective evaluation of these patients was done, DSA findings were noted, and perioperative parameters (surgical approach, extent of resection, operative time, blood loss, blood transfusion, morbidity grade, and length of post-operative stay) were compared with a comparative cohort of 24 patients of PA (21 males, three females, mean age 36.13 ± 12.58 years) who underwent thoracic surgery without PCCE (May 2013–November 2017) (control group) using the Mann–Whitney U test. Results A total of 55 arteries were embolized in 17 patients (mean 3.23 arteries per patient). Technical success could be achieved in all patients without any procedure-related complications. The most common arteries embolized were posterior intercostal arteries (29) followed by costocervical trunk (10), superior thoracic (8), lateral thoracic (5), and internal thoracic arteries (3). The mean blood loss was significantly lower in the embolization group compared with the control group (676.47 vs. 1,264.58 mL, p = 0.015). Within the embolization group, patients who underwent video-assisted thoracoscopic surgery had even lower blood loss compared with open surgery cases (466 vs. 887.50 mL, p-value = 0.046). Conclusion PCCE is a simple and safe procedure, useful in reducing intra-operative blood loss in patients undergoing surgery for peripherally located PA.

Society of Chest Imaging and Interventions Consensus Guidelines for the Interventional Radiology Management of Hemoptysis

“…For persistent hemoptysis, various methods to isolate the diseased lung include selective bronchial intubation, bronchial blocker using balloon tamponade, and double-lumen endotracheal intubation. 16,39,40 The hemodynamic stabilization runs parallel to airway management and includes volume replacement and blood transfusion (including fresh frozen plasma or platelets). Stoppage of any anticoagulant/antiplatelet drugs and reversal agents if available.…”

“…Preoperative embolization may be useful to reduce blood loss in cases of aspergilloma surgery. 40 Surgery is unlikely to be useful in diffuse disease, because of associated high morbidity and mortality, especially in case of emergency surgery. The mortality ranges from 20 to 40% if surgery is performed during active hemoptysis and 10 to 18% when performed electively.…”

Two case reports of preoperative selective artery embolization with robotic-assisted thoracoscopic lobectomy for chronic cavitary pulmonary aspergillosis: technology, safety and short-term outcomes

“…However, few articles have reported on RATS in the treatment of pulmonary aspergillosis ( 2 , 3 ). Selective artery embolization is usually conducted as palliative management or emergent control of hemoptysis in CCPA ( 1 ); meanwhile, it can also greatly reduce intraoperative hemorrhages in the dissection of vascular adhesions, thus providing safety and clear vision for the subsequent surgery ( 4 ). In this article, we report 2 CCPA cases who received selective artery embolization followed by RATS lobectomy.…”