Bronchoscopic placement of custom-made sutured silicone bronchial occluders for refractory hemoptysis: a retrospective case series

Background Refractory hemoptysis remains difficult to control when conventional hemostatic medication is insufficient and arterial embolization fails or is not feasible. This study explored the clinical efficacy and safety of bronchoscopic placement of custom-made sutured silicone bronchial occluders as a palliative airway isolation strategy for selected patients with segmental bleeding. Methods A total of 4 patients with refractory hemoptysis whose bleeding persisted despite hemostatic medication were retrospectively enrolled. Arterial embolization had been attempted in two patients (pulmonary artery embolization in Case 1, with recurrence of hemoptysis after 1 month; selective arteriography with failed embolization in Case 3) and was not performed in the other two, in whom selective angiography identified no suitable embolizable culprit vessel. All four were consecutive eligible patients treated at our center during the study period. The underlying causes included lung cancer cavity, aortic malformation complicated with bronchial fistula, and diaphragmatic arterial bronchial fistula. Preoperative enhanced chest CT was performed to accurately localize the bleeding segmental bronchus and measure its diameter. Under general anesthesia, a rigid bronchoscope (or laryngeal mask) was used to establish airway access, and the occluder was advanced alongside the flexible bronchoscope rather than through its working channel. The conical occluders were individually tailored from medical silicone, shaped and reinforced with non-absorbable sutures, and precisely implanted via bronchoscopy to isolate the bleeding segmental bronchus. Occluder base diameter was typically 15–20% larger than the measured target bronchial diameter to ensure a friction fit. All patients received standardized antitussive treatment postoperatively and were followed up for 12 months. The hemostatic effect and incidence of complications were evaluated. Results All 4 patients underwent successful operation without severe airway injury during the procedure. Active bleeding was no longer visible on immediate post-implantation bronchoscopy in all cases; complete clinical cessation of hemoptysis (including clearance of residual blood) was observed within 24 to 36 h. No recurrence of hemoptysis was observed during the 3-, 6- and 12-month follow-up periods. Only one patient developed low-grade fever (peak temperature 38.1 °C) within 24 h after surgery, which was relieved after symptomatic management. No occluder displacement, airway obstruction, aggravated infection or other severe complications occurred. Given the small sample size and absence of objective pulmonary function testing or validated quality-of-life instruments, no claims are made regarding preservation of pulmonary function or improvement in quality of life. Conclusions In this small, single-center, retrospective feasibility case series, bronchoscopic placement of custom-made sutured silicone bronchial occluders achieved airway isolation and cessation of segmental bleeding in all four patients, with no recurrence during 12-month follow-up and no severe complications. This technique may warrant further investigation as a palliative salvage option for carefully selected patients with refractory, relatively controlled segmental hemoptysis in whom hemostatic medication had failed and arterial embolization was unsuccessful or not feasible. These preliminary findings do not establish superiority over bronchial artery embolization, surgery, or commercially available endobronchial occlusive devices. Clinical trial number Not applicable.