LED BY GRAHAM ATHERTON SUPPORTED BY  GEORGINA POWELL, MARIE KIRWAN & DEBBIE KENNEDY NAC CENTRE MANAGER CHRIS HARRIS TALK G...
Programme <ul><li>1pm  Introduction </li></ul><ul><li>1:05  Ray Ashleigh - Embolisation </li></ul><ul><li>1:45  Questions ...
Definitions <ul><li>Haemoptysis = coughing up blood </li></ul><ul><li>Embolisation = therapeutic blocking of blood  </li><...
The Problem <ul><li>Distressing </li></ul><ul><li>May be life threatening </li></ul><ul><li>Surgery difficult </li></ul><u...
Haemoptysis  - Classification <ul><li>Massive haemoptysis </li></ul><ul><ul><li>>300ml blood/24 hours </li></ul></ul><ul><...
Massive Haemoptysis <ul><li>Emergency </li></ul><ul><ul><li>Death from asphyxiation </li></ul></ul>
Mild to moderate haemoptysis <ul><li>Life interfering </li></ul><ul><ul><li>Debilitating </li></ul></ul><ul><li>May worsen...
Pathophysiology <ul><li>Chronic Inflammation </li></ul><ul><li>Arterial hypertrophy  Acute infection </li></ul><ul><li>New...
Treatment <ul><li>Conservative </li></ul><ul><li>Radiological </li></ul><ul><ul><li>Embolisation </li></ul></ul><ul><ul><l...
Anatomy –Dual blood supply <ul><li>Pulmonary arteries </li></ul><ul><ul><li>Low pressure circulation </li></ul></ul><ul><u...
Bronchial Arterial Anatomy <ul><li>Variable origin </li></ul><ul><li>Most arise from thoracic aorta </li></ul><ul><li>Aber...
 
Collateral Supply <ul><li>Subclavian </li></ul><ul><li>Internal mammary </li></ul><ul><li>Thyrocervical </li></ul><ul><li>...
Bronchial arterial supply <ul><li>Constant </li></ul><ul><ul><li>Lung </li></ul></ul><ul><ul><li>Oesophagus </li></ul></ul...
Technique  <ul><li>X-Ray guided procedure </li></ul><ul><li>Femoral (groin) access </li></ul><ul><li>“ Pinhole” surgery </...
What you will feel <ul><li>Routine monitoring </li></ul><ul><ul><li>Heartbeat (ECG) </li></ul></ul><ul><ul><li>Blood oxyge...
What you will feel <ul><li>Groin cleaned with antiaseptic </li></ul><ul><li>Injection of local anaesthetic </li></ul><ul><...
What you will NOT feel <ul><li>Catheter moving inside </li></ul><ul><li>Pain on injection of particles </li></ul>
 
 
 
 
 
 
After procedure <ul><li>Hole in artery sealed with manual pressure or dissolvable plug </li></ul><ul><li>Variable time of ...
Bronchial Embolisation - Complications <ul><li>Minor - common </li></ul><ul><ul><li>fever </li></ul></ul><ul><ul><li>chest...
 
Results <ul><li>50% patients have multiple blood supply </li></ul><ul><li>Control of haemorrhage in >90% patients </li></u...
Potential for research <ul><li>Use of newer embolic agents </li></ul><ul><ul><li>No benefit in other anatomical areas </li...
Conclusions <ul><li>Bronchial artery embolisation </li></ul><ul><ul><li>Good at controlling bleeding </li></ul></ul><ul><u...
Discussion – part 1 <ul><ul><li>What do you want to hear about in the next 12 months? </li></ul></ul><ul><ul><ul><li>Vitam...
Discussion – part 2 <ul><ul><li>What do you want to hear about in the next 12 months? </li></ul></ul><ul><ul><ul><li>Anxie...
Expert Patients Programme <ul><ul><ul><li>Several of the requests we have had for information and advice are covered in de...
AOB <ul><ul><li>New patients information leaflets (nearly) ready to go </li></ul></ul><ul><ul><ul><li>Complications of ABP...
Nursing Times Award – wish us luck!
Next Month - Speaker <ul><li>Livingstone Chisimba: Q & A session for any medical issues you want to bring up </li></ul><ul...
Thank You <ul><li>“ The best chance we have of beating this illness is to work together” </li></ul><ul><li>Living with it,...
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Bronchial embolisation to treat bleeding caused by chronic pulmonary aspergillosis

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Radiology Consultant at the National Aspergillosis Centre, Ray Ashleigh talks to our patients support group about embolisation as a treatment for haemoptysis (bleeding) caused by chronic pulmonary aspergillosis and aspergilloma.

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Bronchial embolisation to treat bleeding caused by chronic pulmonary aspergillosis

  1. 1. LED BY GRAHAM ATHERTON SUPPORTED BY GEORGINA POWELL, MARIE KIRWAN & DEBBIE KENNEDY NAC CENTRE MANAGER CHRIS HARRIS TALK GIVEN BY RAY ASHLEIGH RADIOLOGY CONSULTANAT AT THE NATIONAL ASPERGILLOSIS CENTRE NATIONAL ASPERGILLOSIS CENTRE UHSM MANCHESTER Support Meeting for Aspergillosis Patients Fungal Research Trust
  2. 2. Programme <ul><li>1pm Introduction </li></ul><ul><li>1:05 Ray Ashleigh - Embolisation </li></ul><ul><li>1:45 Questions </li></ul><ul><li>2:00 Tea & Coffee </li></ul><ul><li>2:15 Discussions: </li></ul><ul><ul><li>What do you want to hear about in the next 12 months? </li></ul></ul><ul><ul><li>Any Other Business </li></ul></ul><ul><li>3:00 Close </li></ul>
  3. 3. Definitions <ul><li>Haemoptysis = coughing up blood </li></ul><ul><li>Embolisation = therapeutic blocking of blood </li></ul><ul><li>vessel </li></ul>
  4. 4. The Problem <ul><li>Distressing </li></ul><ul><li>May be life threatening </li></ul><ul><li>Surgery difficult </li></ul><ul><ul><li>Poor lung function </li></ul></ul><ul><ul><li>Technically challenging </li></ul></ul><ul><ul><li>Significant morbidity/mortality </li></ul></ul><ul><ul><ul><li>1-6% mortality; 25-30% post op morbidity </li></ul></ul></ul>
  5. 5. Haemoptysis - Classification <ul><li>Massive haemoptysis </li></ul><ul><ul><li>>300ml blood/24 hours </li></ul></ul><ul><li>Moderate </li></ul><ul><ul><li>>3 episodes of 100ml/day/week </li></ul></ul><ul><li>Mild </li></ul><ul><ul><li><100ml/day </li></ul></ul>
  6. 6. Massive Haemoptysis <ul><li>Emergency </li></ul><ul><ul><li>Death from asphyxiation </li></ul></ul>
  7. 7. Mild to moderate haemoptysis <ul><li>Life interfering </li></ul><ul><ul><li>Debilitating </li></ul></ul><ul><li>May worsen lung function </li></ul><ul><ul><li>Infective exacerbations </li></ul></ul><ul><li>May be prequel to massive bleed </li></ul>
  8. 8. Pathophysiology <ul><li>Chronic Inflammation </li></ul><ul><li>Arterial hypertrophy Acute infection </li></ul><ul><li>New blood vessel formation </li></ul><ul><li>HAEMOPTYSIS </li></ul>
  9. 9. Treatment <ul><li>Conservative </li></ul><ul><li>Radiological </li></ul><ul><ul><li>Embolisation </li></ul></ul><ul><ul><li>Intracavitary antifungal therapy </li></ul></ul><ul><li>Surgery </li></ul>
  10. 10. Anatomy –Dual blood supply <ul><li>Pulmonary arteries </li></ul><ul><ul><li>Low pressure circulation </li></ul></ul><ul><ul><li>Gas exchange </li></ul></ul><ul><ul><li>Rarely bleed </li></ul></ul><ul><li>Bronchial arteries </li></ul><ul><ul><li>Systemic pressure </li></ul></ul><ul><ul><li>Usual cause of bleeding </li></ul></ul><ul><ul><li>Can be blocked </li></ul></ul>
  11. 11. Bronchial Arterial Anatomy <ul><li>Variable origin </li></ul><ul><li>Most arise from thoracic aorta </li></ul><ul><li>Aberrant origins/ transpleural collaterals common </li></ul><ul><li>CT scanning can be helpful to identify aberrant vessels </li></ul>
  12. 13. Collateral Supply <ul><li>Subclavian </li></ul><ul><li>Internal mammary </li></ul><ul><li>Thyrocervical </li></ul><ul><li>Costocervical </li></ul><ul><li>Intercostal </li></ul><ul><li>Lateral thoracic </li></ul><ul><li>Inferior phrenic </li></ul>
  13. 14. Bronchial arterial supply <ul><li>Constant </li></ul><ul><ul><li>Lung </li></ul></ul><ul><ul><li>Oesophagus </li></ul></ul><ul><ul><li>Pericardium </li></ul></ul><ul><li>Rare </li></ul><ul><ul><li>Coronary </li></ul></ul><ul><ul><li>Spinal cord </li></ul></ul>
  14. 15. Technique <ul><li>X-Ray guided procedure </li></ul><ul><li>Femoral (groin) access </li></ul><ul><li>“ Pinhole” surgery </li></ul><ul><li>Position catheter in target artery </li></ul><ul><li>Inject plastic beads to block artery </li></ul><ul><li>Continue until all feeding arteries occluded </li></ul>
  15. 16. What you will feel <ul><li>Routine monitoring </li></ul><ul><ul><li>Heartbeat (ECG) </li></ul></ul><ul><ul><li>Blood oxygen (pulse oximetry) </li></ul></ul><ul><ul><li>Blood pressure </li></ul></ul><ul><li>Sedation optional </li></ul><ul><li>Nurse present </li></ul><ul><li>Doctor doing the procedure is “scrubbed” </li></ul>
  16. 17. What you will feel <ul><li>Groin cleaned with antiaseptic </li></ul><ul><li>Injection of local anaesthetic </li></ul><ul><ul><li>Stinging </li></ul></ul><ul><li>Pushing when “gate” (vascular sheath) is put in artery </li></ul><ul><li>Warm feeling from contrast (X-Ray dye) </li></ul>
  17. 18. What you will NOT feel <ul><li>Catheter moving inside </li></ul><ul><li>Pain on injection of particles </li></ul>
  18. 25. After procedure <ul><li>Hole in artery sealed with manual pressure or dissolvable plug </li></ul><ul><li>Variable time of bed rest </li></ul><ul><li>Usually home following day </li></ul><ul><ul><li>Some bruising common </li></ul></ul><ul><ul><li>Bleeding after leaving hospital very rare </li></ul></ul><ul><li>Avoid strenuous activity/heavy lifting 5-7 days </li></ul>
  19. 26. Bronchial Embolisation - Complications <ul><li>Minor - common </li></ul><ul><ul><li>fever </li></ul></ul><ul><ul><li>chest pain </li></ul></ul><ul><ul><li>Pain on swallowing </li></ul></ul><ul><li>Major – very rare </li></ul><ul><ul><li>Damage to bronchus </li></ul></ul><ul><ul><li>Broncho oesophageal fistula (short circuit) </li></ul></ul><ul><ul><li>Leg paralysis </li></ul></ul><ul><ul><ul><li>Chemotoxic </li></ul></ul></ul><ul><ul><ul><li>embolic </li></ul></ul></ul><ul><ul><li>TIA/stroke </li></ul></ul>
  20. 28. Results <ul><li>50% patients have multiple blood supply </li></ul><ul><li>Control of haemorrhage in >90% patients </li></ul><ul><li>30-50% rebleed rate at 3 years </li></ul><ul><li>Mean rebleed free interval 9 months </li></ul><ul><ul><ul><li>Serisli et al Int Angio 2008;27:319-28 </li></ul></ul></ul>
  21. 29. Potential for research <ul><li>Use of newer embolic agents </li></ul><ul><ul><li>No benefit in other anatomical areas </li></ul></ul><ul><ul><ul><li>Uterine fibroids </li></ul></ul></ul><ul><li>Drug coated embolic agents </li></ul><ul><ul><li>Anti-fungals </li></ul></ul><ul><ul><li>Proteins to prevent blood vessel growth </li></ul></ul><ul><ul><ul><li>Research is expensive </li></ul></ul></ul><ul><ul><ul><li>Takes up to 10 years to come to market </li></ul></ul></ul>
  22. 30. Conclusions <ul><li>Bronchial artery embolisation </li></ul><ul><ul><li>Good at controlling bleeding </li></ul></ul><ul><ul><li>Rebleed rate is high </li></ul></ul><ul><ul><li>Major complication rate low </li></ul></ul>
  23. 31. Discussion – part 1 <ul><ul><li>What do you want to hear about in the next 12 months? </li></ul></ul><ul><ul><ul><li>Vitamin D </li></ul></ul></ul><ul><ul><ul><li>Q & A from a clinician – send in questions </li></ul></ul></ul><ul><ul><ul><li>Virtual clinic </li></ul></ul></ul><ul><ul><ul><li>Presentation for carers ( Carers Association )? </li></ul></ul></ul><ul><ul><ul><li>Skin/visual sensitivity – January 2012 </li></ul></ul></ul><ul><ul><ul><li>Fatigue & muscle pain </li></ul></ul></ul><ul><ul><ul><li>Cardiothoracic surgery </li></ul></ul></ul><ul><ul><ul><li>Help at home /everyday life (Used to be FALLS service at Manchester) – have moved </li></ul></ul></ul><ul><ul><ul><li>Weight loss – Xmas Party Debbie/Marie? </li></ul></ul></ul><ul><ul><ul><li>Cleaning & freshening products – breathing problems </li></ul></ul></ul><ul><ul><ul><li>Tips for travel insurance </li></ul></ul></ul><ul><ul><ul><li>Carers – coping, impact on their lives </li></ul></ul></ul>
  24. 32. Discussion – part 2 <ul><ul><li>What do you want to hear about in the next 12 months? </li></ul></ul><ul><ul><ul><li>Anxiety/panic attacks – psycological methods to improve </li></ul></ul></ul><ul><ul><ul><li>Practical help with preparing for end of life </li></ul></ul></ul><ul><ul><ul><li>Vaccines </li></ul></ul></ul>
  25. 33. Expert Patients Programme <ul><ul><ul><li>Several of the requests we have had for information and advice are covered in detail in the Expert Patients Programme </li></ul></ul></ul><ul><ul><ul><li>Everyday life- practical problems </li></ul></ul></ul><ul><ul><ul><li>Carer support & advice </li></ul></ul></ul><ul><ul><ul><li>Practical help with end of life </li></ul></ul></ul><ul><ul><ul><li>Help at home </li></ul></ul></ul><ul><ul><ul><li>Psychological support </li></ul></ul></ul><ul><ul><ul><li>EPP is intended to act in a similar way to our support group on these issues and others, but will also show you how to use your NHS to get this support on a regular basis and provides contacts who can help. </li></ul></ul></ul><ul><ul><ul><li>Highly recommended for patients & carers </li></ul></ul></ul>
  26. 34. AOB <ul><ul><li>New patients information leaflets (nearly) ready to go </li></ul></ul><ul><ul><ul><li>Complications of ABPA </li></ul></ul></ul><ul><ul><ul><li>SAFS </li></ul></ul></ul><ul><ul><ul><li>Aspergillus bronchitis – coming soon </li></ul></ul></ul><ul><ul><li>Funguide Cook book – keep sending in recipes </li></ul></ul><ul><ul><li>Calendar – have got help on a ‘mushroom’ calendar </li></ul></ul><ul><ul><ul><li>Colourful </li></ul></ul></ul><ul><ul><ul><li>Can insert informative text on each page </li></ul></ul></ul><ul><ul><ul><li>Downside – although attractive they don’t really have direct relevance to much of what we are trying to put across </li></ul></ul></ul><ul><ul><li>Donate by mobile phone – now in operation, automatically gift aided </li></ul></ul><ul><ul><ul><li>Send ASPR44 2 to 70070 to donate £2, </li></ul></ul></ul><ul><ul><ul><ul><li>can also donate £3, 4, 5 or 10 by substituting the 2 </li></ul></ul></ul></ul><ul><ul><li>Discussing emergency out of hours number – 12345 text </li></ul></ul><ul><li>, </li></ul>
  27. 35. Nursing Times Award – wish us luck!
  28. 36. Next Month - Speaker <ul><li>Livingstone Chisimba: Q & A session for any medical issues you want to bring up </li></ul><ul><li>We need questions!! </li></ul><ul><li>3rd November 2011 in Seminar room 4 </li></ul>
  29. 37. Thank You <ul><li>“ The best chance we have of beating this illness is to work together” </li></ul><ul><li>Living with it, Working with it, Treating it </li></ul>Fungal Research Trust

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