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Thorac Cardiovasc Surg 2022; 70(07): 589-595
DOI: 10.1055/s-0042-1743591
Original Thoracic

Chest-Wall Collateral Embolization to Reduce Surgical Blood Loss in Peripheral Aspergillomas

Ankur Goyal
1   Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
,
Imtiyaz Ahmad Khan
1   Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
,
Aditya Kumar
2   Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
,
Ashu Seith Bhalla
1   Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
,
Raju Sharma
1   Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
,
Abanti Das
1   Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
,
Manjunath Bale
2   Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
,
Rajinder Parshad 
2   Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
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Abstract

Objectives The objective of this study was to present the procedural details and digital subtraction angiography (DSA) findings of perioperative chest-wall collateral embolization (PCCE) and compare intraoperative blood loss in patients of pulmonary aspergilloma (PA) undergoing lung resection with and without PCCE.

Materials and Methods Since November 2017, we have performed PCCE in 17 patients (14 males, three females, age 34.41 ± 12.85 years) before surgery for PA (embolization group). Retrospective evaluation of these patients was done, DSA findings were noted, and perioperative parameters (surgical approach, extent of resection, operative time, blood loss, blood transfusion, morbidity grade, and length of post-operative stay) were compared with a comparative cohort of 24 patients of PA (21 males, three females, mean age 36.13 ± 12.58 years) who underwent thoracic surgery without PCCE (May 2013–November 2017) (control group) using the Mann–Whitney U test.

Results A total of 55 arteries were embolized in 17 patients (mean 3.23 arteries per patient). Technical success could be achieved in all patients without any procedure-related complications. The most common arteries embolized were posterior intercostal arteries (29) followed by costocervical trunk (10), superior thoracic (8), lateral thoracic (5), and internal thoracic arteries (3). The mean blood loss was significantly lower in the embolization group compared with the control group (676.47 vs. 1,264.58 mL, p = 0.015). Within the embolization group, patients who underwent video-assisted thoracoscopic surgery had even lower blood loss compared with open surgery cases (466 vs. 887.50 mL, p-value = 0.046).

Conclusion PCCE is a simple and safe procedure, useful in reducing intra-operative blood loss in patients undergoing surgery for peripherally located PA.

Keywords

chest wall - VATS - artery/arteries (includes all peripheral arteries) - imaging (all modalities) - surgery - complications - tuberculosis

Ethics Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.


An ambispective study on the role of peri-operative chest-wall collateral embolization in patients of chronic fibro-inflammatory lung diseases was approved by the institute ethics committee and the need for informed consent was waived for the retrospective limb. This article focuses on the retrospective evaluation of the patients with PA who underwent surgery at our institute.




Publication History

Received: 24 November 2021

Accepted: 24 January 2022

Article published online:
09 March 2022

© 2022. Thieme. All rights reserved.

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