Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 24595

AbstractMaterial and MethodsResultsDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : September | Volume : 16 | Issue : 9 | Page : OC34 - OC37 Full Version

A Longitudinal Study Evaluating Indications, Efficacy and Complications of Bronchial Artery Embolisation


Published: September 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/58109.16954
Ganesh Nilpatrewar, Nagsen Ramraje, Vishwanath Pujari, Sanchit Mohan, Priti Meshram

1. Senior Medical Officer, Department of Pulmonary Medicine, Grant Government Medical College, Mumbai, Maharashtra, India. 2. Ex- Professor, Department of Pulmonary Medicine, Grant Government Medical College, Mumbai, Maharashtra, India. 3. Associate Professor, Department of Pulmonary Medicine, Grant Government Medical College, Mumbai, Maharashtra, India. 4. Assistant Professor, Department of Pulmonary Medicine, Grant Government Medical College, Mumbai, Maharashtra, India. 5. Professor and Head, Department of Pulmonary Medicine, Grant Government Medical College, Mumbai, Maharashtra, India.

Correspondence Address :
Dr. Sanchit Mohan,
301, High Rise Building, GT Hospital Campus, Mumbai, Maharashtra, India.
E-mail: sanchit.agarwal1992@gmail.com

Abstract

Introduction: Embolisation is defined as the therapeutic introduction of Gelfoam or Poly-Vinyl Alcohol (PVA) particles into the circulation to occlude vessels. Selective embolisation of the bronchial arteries feeding the affected areas could be more effective than surgical intervention which is more hazardous leading to prolong Intensive Care Unit (ICU) stay, air leaks, stump infection.

Aim: To study various indications, success rate, complications, and recurrence after Bronchial Artery Embolisation (BAE).

Materials and Methods: The present longitudinal study was conducted in the Department of Pulmonary Medicine in collaboration with the Department of Interventional Radiology in Grant Medical College and JJ hospital, Mumbai, Maharashtra, India from December 2016 to December 2017. The study was done on 50 patients admitted in view of moderate to massive haemoptysis. Common indications requiring BAE, success rate with gelfoam or PVA particles, and common complications of the procedure were studied. Mean age of presentation with haemoptysis, co-morbidities associated with the disease were also studied. The patients were followed-up for six months. Repeat BAE was done in patients with PVA particles before referring for surgical intervention in cases with recurrent haemoptysis.

Results: The mean age of patients requiring BAE was 37.98 years, with male predominance. Most common indication was pulmonary tuberculosis followed by post-tuberculosis sequelae. The overall success rate of the procedure was 88% at six months follow-up.BAE done with PVA (10/10) particle showed a better outcome as compared to gelfoam (34/40). The most common complication related to the procedure was puncture site pain. Three patients out of six with recurrent haemoptysis required repeat BAE within three months, out of which only one required surgery.

Conclusion: The most common indication for BAE in this study was pulmonary tuberculosis. There were no major complications, even with repeat BAE. Hence, BAE should be the procedure of choice for moderate to massive haemoptysis despite of previous history of BAE, before considering for surgical intervention. BAE with PVA is associated with better success rate.

Keywords

Digital subtraction angiography, Gelfoam, Haemoptysis, Poly-vinyl alcohol, Pulmonary tuberculosis

Embolisation is defined as the “therapeutic introduction of gelfoam particles or PVA particles into the circulation to occlude vessels, either to prevent haemorrhage; or to devitalise a tumour, or organ by occluding its blood supply; or to reduce blood flow to an arteriovenous malformation.” Haemoptysis is a potentially life-threatening clinical event. Patients with chronic inflammatory lung diseases such as bronchiectasis, tuberculosis develop markedly hypertrophied and fragile bronchial arteries that may lead to clinically significant haemoptysis. Surgical intervention is hazardous and often impossible in the patients with diffuse parenchymal lung disease (1). Selective catheterisation of the bronchial arteries followed by particulate embolisation is an effective treatment to control bleeding. BAE was first described by Interventional Radiologist Martine Remy- Jardin in 1973. Since then, the procedure has proven its safety and effectiveness in controlling haemoptysis in diverse lung conditions (2). As BAE does not cure the primary disease, recurrent bleeding can occur, demanding additional embolisation procedures. Though surgery is a treatment of choice in conditions like aspergilloma, hydatid cyst, and thoracic vascular injuries; haemoptysis arising from these conditions can be potentially managed by endovascular approach. BAE in massive haemoptysis not only saves lives in emergency conditions but also bridges the time period before definitely elective surgical management can be undertaken (3). Common causes of haemoptysis are tuberculosis, post-tuberculosis sequalae, aspergilloma, pneumonia, lung abscess, lung cancer, lung sequestration, bleeding disorders, traumatic. Pulmonary tuberculosis and aspergilloma are the most common indications requiring BAE (4).

This study was undertaken at a tertiary care centre with an aim to study common indications requiring BAE, overall success rate and complications and to assess recurrence occurring after BAE within a six months follow-up period.

Material and Methods

The present study was a longitudinal study, conducted in the Department of Pulmonary Medicine in collaboration with the Department of Interventional Radiology in Grant Medical College and JJ hospital, Mumbai, Maharashtra, India from December 2016 to December 2017. The study was approved by Institutional Ethics Committee (IEC) dated 30th November 2016 (423/2016).

Inclusion criteria: Fifty patients with massive haemoptysis who underwent BAE were selected. Both males and females were recruited for the study after taking informed consent. All patients above age of 18 years and with moderate to severe haemoptysis were included in the study.

Exclusion criteria: Patients who did not give consent were excluded from the study.

Patients were embolised with Gelfoam paticles or PVA. Sample size was calculated by non-probability convenient sampling.

All patients were enquired about the nature and duration of their illness and were examined and evaluated for haemoptysis. Haemoptysis was classified as: (3)

1. Mild- <20 mL/day
2. Moderate- 20-500 mL/ day
3. Severe/ Massive- >500 mL/day or 150 mL/hour or 100 mL blood loss per day for three consecutive days.

Detailed history of patients was taken with special consideration to the history of haemoptysis in the past and history of tuberculosis. Underlying co-morbid conditions like diabetes, hypertension, Human Immunodeficiency Virus (HIV), airway disease, anticoagulation, trauma, previous history of bronchial artery embolisation was noted. History regarding substance abuse and addiction was noted. All the patients were preliminary evaluated with investigations like Complete Blood Count (CBC), Blood sugar, Liver Function Test (LFT), Renal Function Test (RFT), Prothrombin Time (PT) and Iinternational Normalized Ratio (INR), Bleeding Time (BT), Clotting Time (CT), X-ray chest Posteroanterior view and Computed Tomography (CT) thorax with contrast. Sputum Acid fast Bacilli (AFB), gram culture and fungal culture, sputum Cartridge Based Nucleic Acid Amplification Test (CBNAAT) was done in the patients after haemoptysis was controlled.

All the patients were initially managed conservatively and attempts to stabilise the patients were made before referring for BAE. The procedure was done by an interventional radiologist in the Interventional Radiology Department (Digital subtraction angiography). Under all aseptic precautions, the right femoral arterial access was taken with 5 F catheter. Selective bronchial artery angiogram was done with Cobra catheter and blush was noted indicating a bleeding site. The study was conducted in a government set-up and because gelfoam particles were cheap and easily available as compared to PVA particles, embolisation was carried out using gelfoam particles in 40 patients and PVA particles in 10 patients only.

Postprocedure check angiogram was carried out to observe the previously bleeding vascular sites. All the patients were advised strict immobilisation for six hours after the removal of sheath. Intra and immediate postprocedure status were noted as puncture site haematoma, pain, or focal neurological deficit. All the complications were managed appropriately. Patients included in the study were reassessed monthly for six months. History regarding symptoms and recurrence of haemoptysis was taken and were managed accordingly. Haemoptysis, if controlled postprocedure and in six-months follow-up, was considered as a successful outcome. Persistant haemoptysis, even after the procedure or recurrence of haemoptysis within six months of the procedure was considered as a failure.

Statistical Analysis

Data was analysed using Statistical Package for the Social Sciences (SPSS)-16.0 software. Descriptive analysis was done on the collected data presented in the form of mean and percentage.

Results

The study included 50 patients with haemoptysis who underwent BAE; gelfoam was used in 40 and PVA was used in 10, and all of them had moderate to massive haemoptysis. The youngest patient was of 18 years old and the oldest was of 69 years. The mean age was 37.98±14 years. Majority of the study population belonged to the age group of 18-30 years (42%) (Table/Fig 1).

The most common aetiology for undergoing BAE was pulmonary tuberculosis followed by post pulmonary tuberculosis fibro-cavitatory lesion. Klebsiella was the most commonly grown pathogen and 2 % patients were fungal culture positive for Aspergillus fumigatus (Table/Fig 2).

The most common co-morbidity was diabetes, and six patients had multiple co-morbid conditions (Table/Fig 3). Out of 50, two patients had previously undergone BAE with gelfoam particles -one patient had bronchiectasis who underwent BAE two years back and the other had Pulmonary Tuberculosis who had history of BAE eight months back. PVA particles were used in these patients.

Post-BAE, all patients were followed-up for six months - haemoptysis was controlled in 10 (100%) patients in whom PVA particle were used, and in 34 (85%) patients in whom gelfoam particles were used. The overall success rate was 88%. The most common procedure-related complication was puncture site pain followed by transient chest pain (Table/Fig 4). At six months it was noticed that 6 out of 40 patients (15%) treated with gelfoam particles had recurrent haemoptysis within three months. Recurrence was not seen in patients treated with PVA particles till the last follow-up (Table/Fig 5).

Patients were followed-up till six months post BAE and none had any recurrence after three months. Three patients had recurrent haemoptysis in 1st month of follow-up which was mild/streaky, two had recurrent haemoptysis in the 2nd month of follow-up which was moderate and required repeat BAE with PVA particles. Both patients who underwent repeat BAE had control of bleeding and there was no recurrence at six months follow-up. Only one patient had severe haemoptysis in the 3rd month of follow-up which required lobectomy (Aspergilloma) even after repeat BAE with PVA particles (Table/Fig 5).

Discussion

The study evaluated 50 patients with moderate to massive haemoptysis in whom BAE was performed at a tertiary care institute. It included 35 males and 15 females, with a mean age of 37.98 years. In the present study, pulmonary tuberculosis (42%) was the main aetiological factor for haemoptysis followed by post-tuberculosis sequelae (30%) which was similar to the studies conducted by Ramakantan R et al., (4), Tanaka N et al., (5), Mal H et al., (6). However, in few other studies, the most common aetiology for haemoptysis were bronchiectasis and lung abscess (7),(8). In this study, bronchial angiography and subsequent embolisation for cases of moderate to massive haemoptysis was performed in the Interventional Radiology department by introducing gelfoam in 40 patients and PVA particles in 10. Ramakantan R et al., (4), used gelatin foam/gel foam particles, Corr PD (9) used tri-acryl microspheres, Baltaciog???lu F et al., (10) used n-butyl-2-cyanoacrylate (NBCA), named ‘glue’, Rabkin JE et al., (11) used albumin macroaggregates as an agent for embolisation. Control of haemoptysis in the present study was achieved with embolisation with PVA particles 10 (100%) and with gelfoam particles 34 (85%) with total success rate of the procedure being 88% (Table/Fig 6) (4),(6),(7),(8),(9),(10),(11),(12),(13),(14),(15),(16).

In a study by Hahn K et al., PVA showed a better success rate as compared to gelfoam, which was similar to the present study (14). Fu Z et al., also reported good success rate of PVA as compared to Microspheres (13).

(Table/Fig 6) shows that the BAE is an effective procedure for control of haemoptysis immediately as well as in follow-up period, few studies showed that BAE done with PVA particles has better outcome in preventing recurrence as compared to gelfoam particles. Out of six patients who had recurrent haemoptysis in the present study, three were treated conservatively and three underwent re-embolization with PVA with successful outcome in two patients and one required Lobectomy. Overall recurrence rate after BAE was low, recurrence if occurred was re-embolized and had shown good outcome. Hahn S et al reported a recurrence rate of 37.5% with PVA, whereas Fu Z et al., reported it to be 0% (12),(13).

Ramakantan R et al., studied 140 patients of whom 38 had recurrence; 29 patients were treated successfully with conservative measures and nine underwent re-embolisation with gelatin foam. Seven patients who underwent re-embolisation had recurrent bleeding; overall recurrence was 27.1% (4). Recurrence in present study was 15% in patients treated with gelfoam particles, PVA particles showed 100% success rate. In the study by Baltaciog???lu F et al., 3 out of 25 patients had recurrence in 12 month follow-up (10). The study by Corr PD (9) showed 13% recurrence in one week follow-up. In a study on 46 patients, Mal H et al., found that immediate success rate was 93%, while the long-term success rate (beyond three months) was 54.34% (6).

Major causes of recurrence after successful BAE includes extrapulmonary-systemic collateral arteries (5), dislodgement of gelfoam particles, anomalous origin of bronchial arteries. Sancho C et al., observed 25 bronchial arteries of anomalous origin in their 27 patients with recurrent haemoptysis (17). The most common procedure-related complication noted in the present study was puncture site pain (48%). It was managed conservatively with analgesics. Only one patient suffered transient unilateral lower limb weakness who showed improvement with physiotherapy within seven days.

Other studies found chest pain to be the most common complication (4),(8),(10),(13). Few patients had transient lower limb weakness but no major neurological complication was noticed (4),(14). Mal H et al., (6) showed mediastinal haematoma as a major complication in few of their patients.

Limitation(s)

The sample size was limited, comparison between gelfoam particles and PVA particles was not done due to limited availability of PVA at the institute. Comparative analysis between surgical outcome (lobectomy) and non surgical procedure (BAE) was not done.

Conclusion

Pulmonary tuberculosis and its sequelae remain the most common causes of haemoptysis requiring BAE in tuberculosis endemic countries followed by bronchiectasis, fungal ball, lung mass. BAE with PVA particles has shown better results in controlling moderate to massive haemoptysis than gelfoam particles. Pain at puncture site is the most common postprocedural complication, BAE is infrequently associated with major and life-threatening complications. Repeat BAE after the failed initial BAE or recurrent haemoptysis was also associated with a good success rate.

References

1.
Stedman T. Stedman’s Medical Dictionary. 27th ed. Lippincott Williams & Wilkins. 2000.
2.
Hayakawa K, Tanaka F, Torizuka T. Bronchial artery embolisation for haemoptysis: Immediateand long-term results. Cardiovasc Intervent Radiol. 1992;15:154-59. Doi: https://doi.org/10.1007/BF02735578. PMID: 1628281. [crossref] [PubMed]
3.
Jean-Baptiste E. Clinical assessment and management of massive haemoptysis. Crit Care Med. 2000;28:1642-47. Doi: https://doi.org/10.1097/00003246-200005000-00066. PMID: 10834728. [crossref] [PubMed]
4.
Ramakantan R, Bandekar VG, Gandhi MS, Aulakh BG, Deshmukh HL. Massive hemoptysis due to pulmonary tuberculosis: Control with bronchial artery embolization. Radiology. 1996;200(3):691-94. Doi: https://doi.org/10.1148/radiology.200.3.8756916. PMID: 8756916. [crossref] [PubMed]
5.
Tanaka N, Yamakado K, Murashima S. Superselective bronchial artery embolization for hemoptysis with a coaxial microcatheter system. J Vasc Interv Radiol. 1997;8(1Pt1):65-70. Doi: https://doi.org/10.1016/S1051-0443(97)70517-7. [crossref]
6.
Mal H, Rullon I, Mellot F. Immediate and long-term results of bronchial artery embolization for life-threatening hemoptysis. Chest. 1999;115(4):996-1001. Doi: https://doi.org/10.1016/S1051-0443(97)70517-7. PMID: 10208199. [crossref]
7.
Remy J, Voisin C, Ribet M. Treatment by embolisation, of severe or repeated hemoptysis associated with systemic hyper vascularization. Nouv Presse Med. 1973;2:2060-68.
8.
Swanson KL, Johnson CM, Prakash UB, McKusick MA, Andrews JC, Stanson AW. Bronchial artery embolization: Experience with 54 patients. Chest. 2002;121(3):789-95. Doi: https://doi.org/10.1378/chest.121.3.789. PMID: 11888961. [crossref] [PubMed]
9.
Corr PD. Bronchial artery embolization for life-threatening hemoptysis using trisacryl microspheres: Short-term result. Cardiovasc Intervent Radiol. 2005;28(4):439-44. Doi: https://doi.org/10.1007/s00270-004-0227-x. PMID: 15959698. [crossref] [PubMed]
10.
Baltaciogğlu F, Cimşit NC, Bostanci K, Yüksel M, Kodalli N. Transarterial microcatheter glue embolization of the bronchial artery for life-threatening hemoptysis: Technical and clinical results. Eur J Radiol. 2010;73(2):380-84. Doi: https://doi.org/10.1016/j.ejrad.2008.10.017. PMID: 19070980. [crossref] [PubMed]
11.
Rabkin JE, Astafjev VI, Gothman LN, Grigorjev YG. Trans catheter embolization in the management of pulmonary hemorrhage. Radiology. 1987;163(2):361-65. Doi: https://doi.org/10.1148/radiology.163.2.3562815. PMID: 3562815. [crossref] [PubMed]
12.
Hahn S, Kim YJ, Kwon W, Cha SW, Lee WY. Comparison of the effectiveness of embolic agents for bronchial artery embolization: Gelfoam versus polyvinyl alcohol. Korean J Radiol. 2010;11(5):542-46. Doi: 10.3348/kjr.2010.11.5.542. PMID: 20808698. [crossref] [PubMed]
13.
Fu Z, Li X, Cai F, Yuan Y, Zhang X, Qin J, et al. Microspheres present comparable efficacy and safety profiles compared with polyvinyl alcohol for bronchial artery embolization treatment in hemoptysis patients. J Transl Med. 2021;19(1):422. Doi: 10.1186/s12967-021-02947-7. PMID: 34635108. [crossref] [PubMed]
14.
Han K, Yoon KW, Kim JH, Kim GM. Bronchial artery embolization for hemoptysis in primary lung cancer: A retrospective review of 84 patients. J Vasc Interv Radiol. 2019;30(3):428-34. Doi: 10.1016/j.jvir.2018.08.022. PMID: 30819488. [crossref] [PubMed]
15.
Uflacker R, Kaemmerer A, Picon PD. Bronchial artery embolization in the management of hemoptysis: Technical aspects and long-term results. Radiology.1985;157(3):637-44. Doi: https://doi.org/10.1148/radiology.157.3.4059552. PMID: 4059552. [crossref] [PubMed]
16.
Ingole S, Pote P, Ingle V, Domkunkar S. Bronchial and nonbronchial systemic artery embolization for life-threatening hemoptysis in tertiary care hospital in western India. Paripex-Indian Journal of Research. 2017;6(1):258-60.
17.
Sancho C, Escalante E, Domínguez J. Embolisation of bronchial arteries of anomalous origin. Cardiovasc Intervent Radiol. 1998;21(4):300-04. Doi: https:// doi.org/10.1007/s002709900265. PMID: 9688797. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2022/58109.16954

Date of Submission: May 31, 2022
Date of Peer Review: Jun 24, 2022
Date of Acceptance: Jul 21, 2022
Date of Publishing: Sep 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jun 07, 2022
• Manual Googling: Jul 19, 2022
• iThenticate Software: Aug 26, 2022 (5%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com