When an inflammatory pulmonary pathology occurs, hyperpressure can occur in the peripheral pulmonary arteries and cause hemoptysis. A study published in the Journal European Radiology evaluates the risk of embolization using small particles. This research work proves the safety and effectiveness of the procedure in question.
Bronchial artery embolization is widely used in the treatment of significant hemoptysis, as a primary method of bleeding control, in secondary prevention, and as a bridge to surgery, while preserving lung function.
Inflammatory pulmonary pathologies which lead to hyperpressure in the peripheral pulmonary arteries
In chronic pulmonary inflammatory conditions, the bronchopulmonary anastomoses increase in size, leading to a pathological shunt with the consequence of hypertrophy of the bronchial arteries irrigating the diseased lung. When pleural inflammation is added, transpleural communications between the systemic non-bronchial and pulmonary arteries can form, leading to hypertrophy of the latter. This is how the intercostal, subclavian or phrenic arteries expose the fragile and inflamed peripheral pulmonary arteries to high systemic arterial pressures, increasing the risk of rupture and bleeding.
Is embolization using small particles risky in this setting?
It is in this context that bronchial arterial embolization is implemented to reduce systemic blood pressure in these friable pulmonary vessels. Particles larger than 300 µm are typically used for this purpose, but smaller particles can act for more distal embolization and obtain better results in terms of persistence or recurrent hemoptysis. A retrospective British study published in the Journal European Radiology attempts to evaluate the results obtained in patients with hemoptysis treated by embolization with polyvinyl alcohol (PVA) particles of 150 to 250 µm.
This work included all patients who underwent bronchial artery embolization between 2010 and 2022 in a single tertiary center, with collection of demographic data, etiology and volume of hemoptysis, success technical and clinical, procedure-related complications and follow-up information. PVA particles of 150 to 250 µm were used in all patients, followed by the use of larger particles in some of them.
Research work that proves the safety and effectiveness of this procedure
One hundred and forty-four patients were treated using 189 procedures and were followed for an average of 35 months. PVA particles of 150 µm to 250 µm were used as the sole embolic agent in 137 cases. Hemoptysis recurs within 30 days in 7%. The median time to repeat the procedure was 144 days and 17 of 144 patients had a branch pulmonary artery pseudoaneurysm. The major complication rate was 1% and thirty-day mortality was 2%.
Researchers have apparently demonstrated the safety and effectiveness of this procedure using 150-250 µm PVA particles with high technical and clinical success rates, good long-term results and low rates of recurrence of hemoptysis at 30 days and overall. The risk of untargeted embolization with small particles is likely overestimated as long as meticulous embolization technique is used by performing frequent diagnostic arteriograms during embolization of individual vessels to assess the progress of embolization.
Paco Carmine
