From the Guidelines
Bronchial artery embolization (BAE) is the recommended first-line treatment for hemoptysis in patients with aspergilloma, with a technical success rate of approximately 90%. For patients experiencing hemoptysis due to aspergilloma, BAE should be performed urgently to control bleeding. The procedure involves selective catheterization of bronchial arteries supplying the aspergilloma, followed by embolization using particles (typically polyvinyl alcohol particles sized 300-500 μm) or gelfoam 1. Prior to the procedure, a CT angiography should be performed to identify the culprit vessels and potential non-bronchial systemic collaterals that may require embolization.
Some key points to consider when performing BAE for hemoptysis in aspergilloma include:
- The high recurrence rate of hemoptysis, ranging from 30-50% in aspergilloma cases, often necessitating repeat procedures 1
- The importance of monitoring patients post-procedure for recurrent bleeding, chest pain, dysphagia, and rare complications like spinal cord ischemia
- The potential need for definitive management with surgical resection for eligible patients, as aspergillomas have a high recurrence rate of hemoptysis due to their hypervascular nature and the erosion of blood vessels within fungal balls 1
- The use of antifungal therapy (such as voriconazole or itraconazole) as an adjunct, but with limited efficacy in established aspergillomas 1
It is essential to note that while BAE is effective in controlling acute bleeding, it may not be a definitive solution for patients with aspergilloma, and repeat procedures or surgical intervention may be necessary to achieve long-term control of hemoptysis. Surgical resection is a definitive treatment option for patients with adequate pulmonary function and should be considered in all patients with severe hemoptysis 1.
From the Research
Hemoptysis in Aspergilloma
- Hemoptysis is a serious complication of pulmonary aspergilloma, and bronchial artery embolization is considered an effective treatment option 2, 3, 4.
- A study published in 2017 found that bronchial artery embolization was successful in stopping bleeding in 84% of cases of massive hemoptysis due to pulmonary aspergilloma 3.
- Another study published in 1988 found that percutaneous intracavitary treatment with amphotericin B, N-acetylcysteine, and aminocaproic acid was effective in treating acute hemoptysis in patients with pulmonary aspergilloma 5.
- The use of polyvinyl alcohol (PVA) particulate embolization, spring coil, and N-butyl cyanoacrylate (NBCA) glue has been shown to be effective in embolizing bleeding arteries in patients with pulmonary aspergilloma 3.
Bronchial Artery Embolization
- Bronchial artery embolization is a minimally invasive technique that can be performed repeatedly, and provides not only short-term but also prolonged effectiveness 2.
- The procedure involves embolizing the bleeding artery to prevent further bleeding, and can be used as a first-line treatment for hemoptysis regardless of the underlying pathological lesion 2, 4.
- A study published in 2008 found that bronchial artery embolization had a high early success rate and relatively low risk compared with alternative medical and surgical treatments 4.
Complications and Limitations
- Bronchial artery embolization is not without complications, and can fail in some cases 2, 6.
- A study published in 2015 found that bronchial arterial embolisation was only partially effective in controlling hemoptysis in a patient with pulmonary aspergillosis, and the patient ultimately required surgical intervention 6.
- The use of bronchial artery embolization should be carefully considered, and patients should be closely monitored for potential complications and the need for additional treatment 2, 4.