Bronchoscopic resection represents a facilitated alternative option for restoration of airway patency in selected cases. However, the procedure is susceptible to complications arising from severe hemorrhaging. This single-center retrospective pilot study aimed to evaluate the safety and feasibility of bronchial artery embolization (BAE) prior to endobronchial resection in patients with central airway obstruction (CAO). Patients with CAO caused by hypervascular tumors with strong enhancement on computed tomography (CT) and/or hemoptysis were included in the study. All neoplasms were excised using argon plasma coagulation during bronchoscopic intervention. Preceding the procedure, selective bronchial artery embolization was conducted to occlude the neoplastic blood supply 48 h in advance. The analysis encompassed an evaluation of hemorrhage severity, reconstruction of airway patency, and associated complications. A total of 24 patients (15 males and 9 females) with central airway obstruction were included for analysis, with a mean age of 61 ± 10 years (42–87 years) and followed-up for a median (range) of 26 (20–54) months. The locations of tumor in the airway included lobar bronchus (17/24, 70.8%) and trachea (7/24, 29.2%). The obstruction degree was Grade III in 15 (62.5%) patients and Grade IV in 9(37.5%) patients. Embolization and bronchoscopy tumor resection were successfully performed in all the patients. Procedure-related minor bleeding occurred in 19 (79.2%) patients and moderate bleeding in 5 (20.8%) patients; No severe bleeding occurred. Reconstruction of airway patency with complete response and partial response were seen in 16 (66.7%) patients and 8 (33.3%) patients, respectively, and symptom relief was achieved in all the patients. Complications after BAE, including chest pain (11/24, 45.8%) and abdominal pain (3/24, 12.5%), were alleviated on the next day after receiving supportive therapies. Fever, shivering, and vomiting occurred in 9/24 (37.5%), 4/24 (16.7%), and 3/24 (12.5%) patients, respectively. Spinal cord injury was not observed in this study. Bronchoscopic resection of airway tumors following selective bronchial artery embolization represents a potentially safe and viable approach for mitigating severe bleeding during the excision of hypervascular airway tumors. Further validation through a comprehensive prospective study is warranted.
He et al. (Tue,) studied this question.