Joo-Young Chun

Radiological management of hemoptysis: a comprehensive review of diagnostic imaging and bronchial arterial embolization.

Hemoptysis can be a life-threatening respiratory emergency and indicates potentially serious underlying intrathoracic disease. Large-volume hemoptysis carries significant mortality and warrants urgent investigation and intervention. Initial assessment by chest radiography, bronchoscopy, and computed tomography (CT) is useful in localizing the bleeding site and identifying the underlying cause. Multidetector CT angiography is a relatively new imaging technique that allows delineation of abnormal bronchial and nonbronchial arteries using reformatted images in multiple projections, which can be used to guide therapeutic arterial embolization procedures. Bronchial artery embolization (BAE) is now considered to be the most effective procedure for the management of massive and recurrent hemoptysis, either as a first-line therapy or as an adjunct to elective surgery. It is a safe technique in the hands of an experienced operator with knowledge of bronchial artery anatomy and the potential pitfalls of the procedure. Recurrent bleeding is not uncommon, especially if there is progression of the underlying disease process. Prompt repeat embolization is advised in patients with recurrent hemoptysis in order to identify nonbronchial systemic and pulmonary arterial sources of bleeding. This article reviews the pathophysiology and causes of hemoptysis, diagnostic imaging and therapeutic options, and technique and outcomes of BAE.

Immediate and long-term outcomes of bronchial and non-bronchial systemic artery embolisation for the management of haemoptysis

ObjectiveTo evaluate the immediate and long-term results of arterial embolisation in the management of haemoptysis and to identify factors influencing outcome.MethodsA retrospective analysis was carried out of the medical records and angiograms of 50 patients who underwent transarterial embolisation for haemoptysis. ResultsThe most frequent causes of haemoptysis included bronchiectasis (16%), active tuberculosis (12%) and aspergilloma (12%). A total of 126 bronchial and non-bronchial systemic arteries were embolised in 62 procedures. Immediate cessation of haemoptysis was achieved in 43 patients (86%). Haemoptysis was controlled in 36 patients (72%), recurred in 14 (28%) and 11 (22%) required repeat embolisation. The worst outcomes were observed in patients with aspergilloma: all six suffered recurrent bleeding and three (50%) died from massive haemoptysis. Aspergilloma was also associated with an increased risk of haemoptysis recurrence (p < 0.05). A good clinical outcome was achieved in those with active tuberculosis and malignancy. Complication rates were low and included transient chest pain, false aneurysm and one case of lower limb weakness. ConclusionBronchial artery embolisation (BAE) is an effective and safe procedure for haemoptysis control in most cases. However, high recurrence and mortality rates are associated with aspergilloma. Early intervention with repeat embolisation is recommended in these patients and elective surgery should be considered.

Complications of Fibroid Embolisation

Uterine artery embolisation (UAE) is a well-established procedure in the treatment of uterine fibroids. It is a safe procedure in experienced hands, but is not without serious complications. As our experience with the procedure has grown, our understanding of the nature and timing of these complications has also improved. A large number of observational studies and comparative studies of UAE versus surgery have reported a range of complication rates. Two large multicentre registries with the largest patient cohorts have also presented their data on adverse events. These complications are classified according to the Society of Interventional Radiology (SIR) guidelines and the evidence for each category is presented in this chapter. It is important to understand the causes of these adverse events and to maintain awareness during and after UAE, in order to ensure prompt diagnosis and appropriate management should they occur.

Superficial Femoral Artery Rupture Following Angioplasty

This case reviews the various options for treating arterial rupture post-angioplasty including a discussion of principles to be adhered to in order to avoid such a situation in the first place.

Acute Renal Artery Occlusion and Trapped Renal Artery Catheter During Infrarenal AAA Stent Grafting

This case reviews the management of an occluded renal artery by the fabric of an aortic stent graft during an EVAR procedure.

Management of a Type 1B Endoleak Following EVAR

This case reviews the management of a distal type 1 endoleak following EVAR by embolization of the internal iliac artery. Displacement of a coil during the procedure is also discussed.

Superficial Femoral Artery Thrombosis Post-angioplasty

This case reviews the different approaches to dealing with acute thrombosis following angioplasty. An example of a thrombolysis regimen is given in addition to technique for thromboaspiration.

Fistula Rupture Post-fistuloplasty

This case outlines management of rupture of an arteriovenous fistula following balloon dilatation of a stenosis with a cutting balloon. Clinical and technical tips are provided for dealing with such a situation acutely.

Persistent Type 2 Endoleak Post-EVAR with Aneurysm Expansion

This case illustrates the treatment of a type 2 endoleak following fenestrated EVAR by coil embolization of the IMA.

Femoral Artery Pseudoaneurysm Treated with Percutaneous Thrombin Injection

This case illustrates the treatment of a post-femoral artery catheterization pseudoaneurysm with ultrasound-guided thrombin injection. Images illustrate the diagnosis and posttreatment appearances.