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Clinical outcome of bronchial artery embolization for hemoptysis from pulmonary aspergilloma: comparison with other diseases
JVIR
’
Posters and Exhibits
S207
Conclusions: Glue embolization with a mixture of NBCA and ethiodized oil can be safely and effectively performed in a variety of interventional radiology applications. Keys to success include careful selection of embolic targets, optimizing the ratio of NBCA and ethiodized oil, delivery of an appropriate volume, and assessment of the embolic effect with imaging.
Educational Exhibit
Abstract No. 463
3. Carnevale FC, Antunes AA. Prostatic artery embolization for enlarged prostates due to benign prostatic hyperplasia. How I do it. Cardiovasc Intervent Radiol 2013; 36(6):1452–1463. http://dx.doi.org/10.1007/s00270-013-0680-5. 4. Pisco J, Campos Pinheiro L, Bilhim T, Duarte M, Rio Tinto H, Fernandes L, et al. Prostatic arterial embolization for benign prostatic hyperplasia: short and intermediate-term results. Radiology 2013; 266:668–677. http://dx.doi.org/10. 1148/radiol.12111601.
Abstract No. 464 Clinical outcome of bronchial artery embolization for hemoptysis from pulmonary aspergilloma: comparison with other diseases
J. Hughes1, A. Isaacson2, C. Burke2; 1University of Oklahoma College of Medicine, Oklahoma City, OK; 2 UNC Dept of Radiology, Chapel Hill, NC
M. Shimohira, T. Hashizume, T. Kawai, K. Ohta, K. Suzuki, Y. Shibamoto; Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
Learning Objectives: To familiarize interventional radiologists (IR’s) with medications relevant to prostatic artery embolization (PAE). Materials: As the evidence for PAE accrues, more IR’s will potentially be performing this procedure. To be successful, it is important for IR’s to become familiar with common benign prostatic hyperplasia (BPH) medications as well as periprocedural medical management. Clinical Findings/Procedure Details: There are three classes of medications commonly used to alleviate lower urinary tract symptoms (LUTS) secondary to BPH. Alpha-adrenergic inhibitors, such as tamsulosin, alfuzosin and silodosin, act by suppressing smooth muscle contraction within the prostate resulting in immediate decreased pressure on the urethra. 5alpha reductase inhibitors, including finasteride and dutasteride, inhibit the conversion of testosterone to dihydrotestosterone and result in decreased prostatic volume after several weeks. Finally, the use of a phosphodiesterase inhibitor (tadalafil) is approved for treatment of BPH though its mechanism of action is unknown. There are also multiple herbal remedies for BPH, of which the most common is saw palmetto. There are several medications that are useful after the PAE procedure. Acute inflammation that occurs as a result of ischemia to the prostate can result in post-procedural urinary retention. To prevent this, the inflammation can be controlled with a short steroid taper as well as scheduled NSAIDs. Patients may have post-embolization urinary frequency that can be effectively treated with an anticholinergic agent, such as oxybutinin, to inhibit bladder spasm. In addition, phenazopyridine, which acts as an analgesic to the urinary mucosa, is used to treat urethralgia, Acute prostatitis, which can occur weeks to months after PAE, is treated with a combination of antibiotics (commonly ciprofloxacin or trimethoprim/sulfamethoxazole) and NSAIDs. Conclusions: As IR’s begin to treat BPH, it is important to have a thorough understanding of the medications commonly used for LUTS and for managing potential side effects of PAE.
Purpose: The aim of this study is to clarify the clinical outcome of bronchial artery embolization (BAE) for hemoptysis from pulmonary aspergilloma, in comparison with the outcome for other diseases. Materials: Fifty-six patients, 34 males and 22 females, with a median age of 70 years (range, 32–92), underwent BAE using gelatin sponge and/or glue, between April 2003 and July 2015. The etiology of hemoptysis was pulmonary aspergilloma in 9 (PA group) and other diseases in 47 (control group: bronchiectasis in 25, obsolete tuberculosis in 9, lung carcinoma in 3, and other in 10). We reviewed medical records and images, and evaluated the technical success rate, clinical success rate, and complication. Technical success was defined as the complete cessation of the target artery as confirmed by digital subtraction angiography (DSA). Clinical success was defined as the cessation of hemoptysis within 30 days of BAE. Complications associated with BAE were evaluated by physical examinations and blood tests. Results: Complete cessation was confirmed by DSA at the end of all procedures (56/56). Therefore, the technical success rate was 100% in both groups. Nine of 47 patients in the control group, and two of 9 patients in the PA group could not be followed, and thus the clinical success was evaluated in 38 patients in the control group, and 7 in the PA group. In the control group, re-hemoptysis within 30 days was found in 6 of 38 patients, and all 6 patients underwent re-BAE. In the PA group, re-hemoptysis within 30 days was found in 6 of 7 patients. Three of the 6 patients underwent re-BAE, one was converted to lobectomy, and two died of re-hemoptysis. Therefore, the clinical success rate was 84% (32/38) in the control group, and 14% (1/7) in the PA group, with a significant difference (P o 0.05). There was no complication associated with BAE in both groups. Conclusions: The clinical outcome of BAE for hemoptysis from pulmonary aspergilloma was markedly worse than from other diseases.
References 1. Bagla S, Rholl KS, Sterling KM, et al. Utility of cone-beam CT Imaging in prostatic artery embolization. J Vasc Interv Radiol 2013; 24:1603–1607. http:// dx.doi.org/10.1016/j.jvir.2013.06.024. 2. Bagla S, Martin C, van Breda A, Sheridan MJ, Sterling KM, Papadouris D, et al. Early results from a United States trial of prostatic artery embolization in the treatment of benign prostatic hyperplasia. J Vasc Interv Radiol 2014; 25:47–52. http://dx.doi.org/10.1016/j.jvir.2013.09.010.
Abstract No. 465 Transcatheter Arterial Embolization for Traumatic Mesenteric Bbleeding: a 15-year, Single Center Experience J. Shin1, J. Shin2, H. Shim3; 1Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea; 2Asan
Posters and Exhibits
Prostatic artery embolization peri-procedural pharmacologic agents: what the interventional radiologist should know
’
Posters and Exhibits
S207
Conclusions: Glue embolization with a mixture of NBCA and ethiodized oil can be safely and effectively performed in a variety of interventional radiology applications. Keys to success include careful selection of embolic targets, optimizing the ratio of NBCA and ethiodized oil, delivery of an appropriate volume, and assessment of the embolic effect with imaging.
Educational Exhibit
Abstract No. 463
3. Carnevale FC, Antunes AA. Prostatic artery embolization for enlarged prostates due to benign prostatic hyperplasia. How I do it. Cardiovasc Intervent Radiol 2013; 36(6):1452–1463. http://dx.doi.org/10.1007/s00270-013-0680-5. 4. Pisco J, Campos Pinheiro L, Bilhim T, Duarte M, Rio Tinto H, Fernandes L, et al. Prostatic arterial embolization for benign prostatic hyperplasia: short and intermediate-term results. Radiology 2013; 266:668–677. http://dx.doi.org/10. 1148/radiol.12111601.
Abstract No. 464 Clinical outcome of bronchial artery embolization for hemoptysis from pulmonary aspergilloma: comparison with other diseases
J. Hughes1, A. Isaacson2, C. Burke2; 1University of Oklahoma College of Medicine, Oklahoma City, OK; 2 UNC Dept of Radiology, Chapel Hill, NC
M. Shimohira, T. Hashizume, T. Kawai, K. Ohta, K. Suzuki, Y. Shibamoto; Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
Learning Objectives: To familiarize interventional radiologists (IR’s) with medications relevant to prostatic artery embolization (PAE). Materials: As the evidence for PAE accrues, more IR’s will potentially be performing this procedure. To be successful, it is important for IR’s to become familiar with common benign prostatic hyperplasia (BPH) medications as well as periprocedural medical management. Clinical Findings/Procedure Details: There are three classes of medications commonly used to alleviate lower urinary tract symptoms (LUTS) secondary to BPH. Alpha-adrenergic inhibitors, such as tamsulosin, alfuzosin and silodosin, act by suppressing smooth muscle contraction within the prostate resulting in immediate decreased pressure on the urethra. 5alpha reductase inhibitors, including finasteride and dutasteride, inhibit the conversion of testosterone to dihydrotestosterone and result in decreased prostatic volume after several weeks. Finally, the use of a phosphodiesterase inhibitor (tadalafil) is approved for treatment of BPH though its mechanism of action is unknown. There are also multiple herbal remedies for BPH, of which the most common is saw palmetto. There are several medications that are useful after the PAE procedure. Acute inflammation that occurs as a result of ischemia to the prostate can result in post-procedural urinary retention. To prevent this, the inflammation can be controlled with a short steroid taper as well as scheduled NSAIDs. Patients may have post-embolization urinary frequency that can be effectively treated with an anticholinergic agent, such as oxybutinin, to inhibit bladder spasm. In addition, phenazopyridine, which acts as an analgesic to the urinary mucosa, is used to treat urethralgia, Acute prostatitis, which can occur weeks to months after PAE, is treated with a combination of antibiotics (commonly ciprofloxacin or trimethoprim/sulfamethoxazole) and NSAIDs. Conclusions: As IR’s begin to treat BPH, it is important to have a thorough understanding of the medications commonly used for LUTS and for managing potential side effects of PAE.
Purpose: The aim of this study is to clarify the clinical outcome of bronchial artery embolization (BAE) for hemoptysis from pulmonary aspergilloma, in comparison with the outcome for other diseases. Materials: Fifty-six patients, 34 males and 22 females, with a median age of 70 years (range, 32–92), underwent BAE using gelatin sponge and/or glue, between April 2003 and July 2015. The etiology of hemoptysis was pulmonary aspergilloma in 9 (PA group) and other diseases in 47 (control group: bronchiectasis in 25, obsolete tuberculosis in 9, lung carcinoma in 3, and other in 10). We reviewed medical records and images, and evaluated the technical success rate, clinical success rate, and complication. Technical success was defined as the complete cessation of the target artery as confirmed by digital subtraction angiography (DSA). Clinical success was defined as the cessation of hemoptysis within 30 days of BAE. Complications associated with BAE were evaluated by physical examinations and blood tests. Results: Complete cessation was confirmed by DSA at the end of all procedures (56/56). Therefore, the technical success rate was 100% in both groups. Nine of 47 patients in the control group, and two of 9 patients in the PA group could not be followed, and thus the clinical success was evaluated in 38 patients in the control group, and 7 in the PA group. In the control group, re-hemoptysis within 30 days was found in 6 of 38 patients, and all 6 patients underwent re-BAE. In the PA group, re-hemoptysis within 30 days was found in 6 of 7 patients. Three of the 6 patients underwent re-BAE, one was converted to lobectomy, and two died of re-hemoptysis. Therefore, the clinical success rate was 84% (32/38) in the control group, and 14% (1/7) in the PA group, with a significant difference (P o 0.05). There was no complication associated with BAE in both groups. Conclusions: The clinical outcome of BAE for hemoptysis from pulmonary aspergilloma was markedly worse than from other diseases.
References 1. Bagla S, Rholl KS, Sterling KM, et al. Utility of cone-beam CT Imaging in prostatic artery embolization. J Vasc Interv Radiol 2013; 24:1603–1607. http:// dx.doi.org/10.1016/j.jvir.2013.06.024. 2. Bagla S, Martin C, van Breda A, Sheridan MJ, Sterling KM, Papadouris D, et al. Early results from a United States trial of prostatic artery embolization in the treatment of benign prostatic hyperplasia. J Vasc Interv Radiol 2014; 25:47–52. http://dx.doi.org/10.1016/j.jvir.2013.09.010.
Abstract No. 465 Transcatheter Arterial Embolization for Traumatic Mesenteric Bbleeding: a 15-year, Single Center Experience J. Shin1, J. Shin2, H. Shim3; 1Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea; 2Asan
Posters and Exhibits
Prostatic artery embolization peri-procedural pharmacologic agents: what the interventional radiologist should know