MASİF HEMOPTİZİLİ HASTALARIN TEDAVİSİNDE TEK MERKEZ DENEYİMİMİZ

Amaç: Hemoptizi hayatı tehdit eden ve hızlı tanı konulup tedavi edilmesi gereken bir durumdur. Bizim bu çalışmadaki amacımız merkezimizin masif hemoptizi vakalarında uyguladığı süperselektif arteriyel embolizasyonun başarısını değerlendirmek, bu tür hastaların demografik ve klinik özelliklerini belirlemek, yapılan işlemin etkinliğini ve komplikasyonlarını belgelemektir. Materyal ve Metot: Çalışmaya, merkezimizin acil servis veya göğüs hastalıkları bölümüne hemoptizi ile başvuran ve endovasküler tedavi yapılmış olan 72 hasta dahil edilmiştir. Bu hastaların demografik, klinik ve radyolojik verileri retrospektif olarak analiz edilmiştir Bulgular: Hastaların ortanca yaşı 55’ti (min-maks; 22-78). Hastaların 25’i (%34,70) kadın 47’si erkekti (%65.30). Hastalardan 16’sının işlem öncesi tanısı akciğer kanseri, 7’sinin alveolar hemoraji, 1’nin malign melanoma bağlı akciğer metastazı,2’nin histopatolojisi belirsiz hiler ve mediastinal kitle, 4’nün tüberküloz, 4 ‘nün pulmoner tromboemboli, 1’nin sarkoidoz, 2’nin pnömoni,1’nin siroza bağlı hepatopulmoner sendrom ve 34’ninki bronşiektaziydi. Embolize edilen damar 32 vakada sağ bronşiyal arter, 9 vakada sol bronşiyal arter, 15 vakada bilateral bronşiyal arter, 10 vakada kostobronşiyal arter ve 6 vakada bronşiyal dışı arterdi. En sık saptanan üç anjiyografik görünüm vasküler hipertrofi, vasküler iregülerite ve kontrast madde akümülasyonu idi. Kısa vadeli klinik başarı oranı %100’dü.12 vakada ilk bir ay içinde tekrar kanama izlendi. En sık görülen komplikasyon geçici göğüs ağrısıydı. Sonuç: Deneyimli ellerde masif hemoptizin en iyi minimal invaziv tedavi yöntemi selektif arteriyel embolizasyondur. Çalışmamız bu yöntemin etkinliğini ve güvenilirliğini doğrulamıştır.

OUR SINGLE CENTER EXPERIENCE IN TREATING PATIENTS WITH MASSIVE HEMOPTYSIS

Objectives: Hemoptysis is a life-threatening condition and requires immediate diagnosis and treatment. Here in this study, our aim was to demonstrate our single-center experience of super-selective arterial embolization in cases of massive hemoptysis, to describe the demographic and clinical data of those patients, to evaluate thesuccess rate of the intervention, and to document the complications.Materials and Methods: In this study, a total of 72 patients admitted to our tertiary center’s emergency service or chest diseases department and underwent endovascular treatment were enrolled. The demographic and clinical data were analyzed retrospectively.Results: The median age was 55 years (min-max; 22-78). 25 patients (34.70%) were female whereas 47 (65.30%) were male. 16 patients were diagnosed with lung cancer (squamous cell / adeno cancer), 7 alveolar hemorrhages, 1 pulmonary metastasis of malign melanoma, 2 mediastinal and hilar mass of unknown origin, 4 tuberculosis, 4 pulmonary thromboembolism, 1 sarcoidosis, 2 pneumonia, 1 cirrhosis, and hepatopulmonary syndrome and 34 patients with bronchiectasis. The embolized vessel was right bronchial in 32 cases, left bronchial in 9, bilateral in 15, costo-bronchial trunk in 10, and non-bronchial in 6 patients. The most common angiographic pattern was vascular hypertrophy followed by vascular irregularity and blush. Theimmediate clinical success was 100%. Rebleeding occurred in 12 patients due to recanalization of the vessel. The most common complication was chest pain.Conclusion: In experienced hands, arterial embolization is the most effective and minimally invasive procedure to treat massive and recurrent hemoptysis. This study confirms the efficacy and safety of the intervention.

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