Hemoptysis surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]

Overview

Massive hemoptysis is a life-threatening condition and requires prompt intensive care. Surgery is indicated in patients with hemoptysis who are resistant to embolization. Interventional techniques are used to stop bleeding which include bronchial arterial embolization, different bronchoscopic strategies such as cold saline lavage, topical vasoconstrictor agents, balloon tamponade, endobronchial stent placement, endobronchial spigot, oxidized regenerated cellulose, N-Butyl cyanoacrylate glue, fibrinogen thrombin, tranexamic acid, laser photocoagulation, argon plasma coagulation, and electrocautery. Surgical techniques that are used for management of hemoptysis include pulmonary resection, lobectomy, and bilobectomy. Surgical techniques are definitely curative, effective for localized lesions. However, surgery has a mortality rate of 10-30%. Currently, bronchial arterial embolization considered as a first line therapy for both new and recurrent hemoptysis.

Indications

Surgical intervention is recommended for the management of massive hemoptysis.^[1]
Massive hemoptysis is a life-threatening condition and requires prompt intensive care.^[2]^[3]
Surgery is indicated in patients with hemoptysis who are resistant to embolization, such as:

Interventional Procedures

Interventional techniques are used to stop bleeding which include:^[4]^[5]^[6]^[7]^[8]
- Bronchial arterial embolization which is:^[9]^[10]^[11]^[12]^[13]^[14]^[15]
  - Considered as a first line therapy for both new and recurrent hemoptysis
  - Less invasive and reliable procedure
  - Operator-dependent technique
  - Excellent outcome with immediate control of bleeding reaching 80-94%

Other bronchoscopic strategies that are used to stop bleeding in a patient with hemoptysis include:
- Cold saline lavage
- Topical vasoconstrictor agents
- Balloon tamponade
- Endobronchial stent placement
- Endobronchial spigot
- Oxidized regenerated cellulose
- N-Butyl cyanoacrylate glue
- Fibrinogen thrombin
- Tranexamic acid
- Laser photocoagulation
- Argon plasma coagulation
- Electrocautery

Surgery

Patients with massive hemoptysis must be admitted in the ICU and prompt surgical and medical interventions must be started.^[1]
An appropriate team of cardiothoracic surgery, pulmonary medicine, anesthesia, and interventional radiology is required to manage the massive hemoptysis.^[16]^[7]^[17]
Surgery was a first line therapy for massive hemoptysis in the past.
After introduction of bronchial arterial embolization in the 1970s, approaches toward massive hemoptysis were changed.
Surgical techniques that are used for management of hemoptysis include:
- Pulmonary resection:^[14]
  - It is definitely curative.
  - It is effective for localized lesions.
  - It has a mortality rate of 10-30%.
  - Rigid bronchoscopy procedure before surgery improves the outcome by clearing the airway and stabilizing patients in emergency situations.

Other techniques that are used to manage hemoptysis include:^[14]
- Lobectomy
- Bilobectomy

References

↑ ^1.0 ^1.1 Johnson JL (2002). "Manifestations of hemoptysis. How to manage minor, moderate, and massive bleeding". Postgrad Med. 112 (4): 101–6, 108–9, 113. PMID 12400152.
↑ Dudha M, Lehrman S, Aronow WS, Rosa J (2009). "Hemoptysis: diagnosis and treatment". Compr Ther. 35 (3–4): 139–49. PMID 20043609.
↑ Liippo K, Vasankari T (2011). "[Hemoptysis]". Duodecim (in Finnish). 127 (2): 178–84. PMID 21442867.
↑ Mal H, Thabut G, Plantier L (2003). "[Hemoptysis]". Rev Prat (in French). 53 (9): 975–9. PMID 12816036.
↑ Dweik RA, Stoller JK (1999). "Role of bronchoscopy in massive hemoptysis". Clin. Chest Med. 20 (1): 89–105. PMID 10205720.
↑ Joskin J, Bruls S, Brisbois D (2012). "[Bronchial artery ligation for the management of hemoptysis]". Rev Med Liege (in French). 67 (1): 21–5. PMID 22420099.
↑ ^7.0 ^7.1 Sakr L, Dutau H (2010). "Massive hemoptysis: an update on the role of bronchoscopy in diagnosis and management". Respiration. 80 (1): 38–58. doi:10.1159/000274492. PMID 20090288.
↑ Darwiche K, Karpf-Wissel R, Freitag L (2013). "[Hemoptysis--targets in diagnostic and therapy]". Dtsch. Med. Wochenschr. (in German). 138 (11): 530–5. doi:10.1055/s-0032-1332907. PMID 23463474.
↑ Andersen PE (2006). "Imaging and interventional radiological treatment of hemoptysis". Acta Radiol. 47 (8): 780–92. doi:10.1080/02841850600827577. PMID 17018424.
↑ Ramírez Mejía AR, Méndez Montero JV, Vásquez-Caicedo ML, Bustos García de Castro A, Cabeza Martínez B, Ferreirós Domínguez J (2016). "Radiological Evaluation and Endovascular Treatment of Hemoptysis". Curr Probl Diagn Radiol. 45 (3): 215–24. doi:10.1067/j.cpradiol.2015.07.007. PMID 26293972.
↑ Ishikawa H, Hara M, Ryuge M, Takafuji J, Youmoto M, Akira M, Nagasaka Y, Kabata D, Yamamoto K, Shintani A (2017). "Efficacy and safety of super selective bronchial artery coil embolisation for haemoptysis: a single-centre retrospective observational study". BMJ Open. 7 (2): e014805. doi:10.1136/bmjopen-2016-014805. PMC 5318547. PMID 28213604.
↑ Ittrich H, Klose H, Adam G (2015). "Radiologic management of haemoptysis: diagnostic and interventional bronchial arterial embolisation". Rofo. 187 (4): 248–59. doi:10.1055/s-0034-1385457. PMID 25372159.
↑ Reechaipichitkul W, Latong S (2005). "Etiology and treatment outcomes of massive hemoptysis". Southeast Asian J. Trop. Med. Public Health. 36 (2): 474–80. PMID 15916059.
↑ ^14.0 ^14.1 ^14.2 Shigemura, Norihisa; Wan, Innes Y.; Yu, Simon C.H.; Wong, Randolph H.; Hsin, Michael K.Y.; Thung, Hoi K.; Lee, Tak-Wai; Wan, Song; Underwood, Malcolm J.; Yim, Anthony P.C. (2009). "Multidisciplinary Management of Life-Threatening Massive Hemoptysis: A 10-Year Experience". The Annals of Thoracic Surgery. 87 (3): 849–853. doi:10.1016/j.athoracsur.2008.11.010. ISSN 0003-4975.
↑ Noë, G.D.; Jaffé, S.M.; Molan, M.P. (2011). "CT and CT angiography in massive haemoptysis with emphasis on pre-embolization assessment". Clinical Radiology. 66 (9): 869–875. doi:10.1016/j.crad.2011.03.001. ISSN 0009-9260.
↑ Corder R (2003). "Hemoptysis". Emerg. Med. Clin. North Am. 21 (2): 421–35. PMID 12793622.
↑ Schwizer B (2006). "[Acute hemoptysis]". Ther Umsch (in German). 63 (5): 355–9. doi:10.1024/0040-5930.63.5.355. PMID 16739895.

[pmid12400152-1] 1.0 ^1.1 Johnson JL (2002). "Manifestations of hemoptysis. How to manage minor, moderate, and massive bleeding". Postgrad Med. 112 (4): 101–6, 108–9, 113. PMID 12400152.

[pmid20043609-2] Dudha M, Lehrman S, Aronow WS, Rosa J (2009). "Hemoptysis: diagnosis and treatment". Compr Ther. 35 (3–4): 139–49. PMID 20043609.

[pmid21442867-3] Liippo K, Vasankari T (2011). "[Hemoptysis]". Duodecim (in Finnish). 127 (2): 178–84. PMID 21442867.

[pmid12816036-4] Mal H, Thabut G, Plantier L (2003). "[Hemoptysis]". Rev Prat (in French). 53 (9): 975–9. PMID 12816036.

[pmid10205720-5] Dweik RA, Stoller JK (1999). "Role of bronchoscopy in massive hemoptysis". Clin. Chest Med. 20 (1): 89–105. PMID 10205720.

[pmid22420099-6] Joskin J, Bruls S, Brisbois D (2012). "[Bronchial artery ligation for the management of hemoptysis]". Rev Med Liege (in French). 67 (1): 21–5. PMID 22420099.

[pmid20090288-7] 7.0 ^7.1 Sakr L, Dutau H (2010). "Massive hemoptysis: an update on the role of bronchoscopy in diagnosis and management". Respiration. 80 (1): 38–58. doi:10.1159/000274492. PMID 20090288.

[pmid23463474-8] Darwiche K, Karpf-Wissel R, Freitag L (2013). "[Hemoptysis--targets in diagnostic and therapy]". Dtsch. Med. Wochenschr. (in German). 138 (11): 530–5. doi:10.1055/s-0032-1332907. PMID 23463474.

[pmid17018424-9] Andersen PE (2006). "Imaging and interventional radiological treatment of hemoptysis". Acta Radiol. 47 (8): 780–92. doi:10.1080/02841850600827577. PMID 17018424.

[pmid26293972-10] Ramírez Mejía AR, Méndez Montero JV, Vásquez-Caicedo ML, Bustos García de Castro A, Cabeza Martínez B, Ferreirós Domínguez J (2016). "Radiological Evaluation and Endovascular Treatment of Hemoptysis". Curr Probl Diagn Radiol. 45 (3): 215–24. doi:10.1067/j.cpradiol.2015.07.007. PMID 26293972.

[pmid28213604-11] Ishikawa H, Hara M, Ryuge M, Takafuji J, Youmoto M, Akira M, Nagasaka Y, Kabata D, Yamamoto K, Shintani A (2017). "Efficacy and safety of super selective bronchial artery coil embolisation for haemoptysis: a single-centre retrospective observational study". BMJ Open. 7 (2): e014805. doi:10.1136/bmjopen-2016-014805. PMC 5318547. PMID 28213604.

[pmid25372159-12] Ittrich H, Klose H, Adam G (2015). "Radiologic management of haemoptysis: diagnostic and interventional bronchial arterial embolisation". Rofo. 187 (4): 248–59. doi:10.1055/s-0034-1385457. PMID 25372159.

[pmid15916059-13] Reechaipichitkul W, Latong S (2005). "Etiology and treatment outcomes of massive hemoptysis". Southeast Asian J. Trop. Med. Public Health. 36 (2): 474–80. PMID 15916059.

[ShigemuraWan2009-14] 14.0 ^14.1 ^14.2 Shigemura, Norihisa; Wan, Innes Y.; Yu, Simon C.H.; Wong, Randolph H.; Hsin, Michael K.Y.; Thung, Hoi K.; Lee, Tak-Wai; Wan, Song; Underwood, Malcolm J.; Yim, Anthony P.C. (2009). "Multidisciplinary Management of Life-Threatening Massive Hemoptysis: A 10-Year Experience". The Annals of Thoracic Surgery. 87 (3): 849–853. doi:10.1016/j.athoracsur.2008.11.010. ISSN 0003-4975.

[NoëJaffé2011-15] Noë, G.D.; Jaffé, S.M.; Molan, M.P. (2011). "CT and CT angiography in massive haemoptysis with emphasis on pre-embolization assessment". Clinical Radiology. 66 (9): 869–875. doi:10.1016/j.crad.2011.03.001. ISSN 0009-9260.

[pmid12793622-16] Corder R (2003). "Hemoptysis". Emerg. Med. Clin. North Am. 21 (2): 421–35. PMID 12793622.

[pmid16739895-17] Schwizer B (2006). "[Acute hemoptysis]". Ther Umsch (in German). 63 (5): 355–9. doi:10.1024/0040-5930.63.5.355. PMID 16739895.

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