RESUMEN
PURPOSE: Severe hemoptysis (SH) in lung cancer patients admitted to the intensive care unit (ICU) treated with bronchial artery embolization (BAE) is associated with a high risk of recurrent hemoptysis. The purpose of this study was to identify clinical, radiological and angiographic characteristics associated with recurrent hemoptysis MATERIALS AND METHODS: 144 consecutive lung cancer patients who underwent BAE for life-threatening hemoptysis admitted in the ICU between 2014 and 2022 were retrospectively included. Demographics, laboratory values, clinical course, and radiological/angiographic features were compared between those with and without recurrent hemoptysis within one-month post-embolization. RESULTS: Of the 144 patients (mean age of 60.2 ± 10.9 years, 15.3% females), 34.7% (50/144) experienced significant recurrent hemoptysis within one month, among them 29/50 (58.0%) necessitated a second embolization. Massive hemoptysis was observed in 54.2%, with 16.7% receiving Terlipressin. The mean volume of hemoptysis and SAPS 2 score were 235 ± 214.3ml and 31.2 ± 18.6, respectively. Multidetector computed tomographic angiography (MDCTA) revealed pulmonary artery injury (11.5%), necrosis/cavitation (25.8%), and pulmonary artery embolization was performed in 15.3% of cases. Technical success was 92%. SAPS 2 (p = 0.01), massive hemoptysis (p < 0.001), Terlipressin use (p = 0.01), necrosis/cavitation (p = 0.01), and pulmonary artery injury on MDCTA (p < 0.001) were associated with recurrent hemoptysis. Independent predictors on multivariate analysis were massive hemoptysis (p = 0.016) and pulmonary artery injury on MDCTA (p = 0.001). CONCLUSION: In patients with lung cancer and life-threatening hemoptysis treated by BAE, massive hemoptysis and pulmonary artery injury identified on MDCTA are independent predictors of recurrent hemoptysis.
RESUMEN
BACKGROUND: Varicocele embolization is an effective, minimally invasive treatment option, with a symptom improvement rate of around 90%. However, anatomical variations and post-embolization recurrences pose challenges to its efficacy. This article discusses the antegrade embolization technique as a viable alternative for cases in which retrograde embolization fails, offering a broader spectrum of treatment options for varicocele. CASE PRESENTATION: This case report details the treatment of a 27-year-old male with a left varicocele, diagnosed during infertility assessment, using an alternative embolization technique. Despite initial failed attempts at retrograde catheterization via the femoral vein, a direct inguinal puncture of the left testicular vein was successfully performed under ultrasound guidance. A mixture of Glubran® and Lipiodol® was used for embolization, achieving varicocele embolization without complications. The patient was discharged 2 hours post-procedure, with follow-up confirming the procedure's effectiveness and safety. CONCLUSION: This article introduces a less invasive, ultrasound-guided technique for varicocele embolization, presenting a viable alternative to surgery when conventional retrograde methods fail.