open access

Vol 89, No 4 (2021)
Research paper
Published online: 2021-09-02
Submitted: 2021-03-13
Accepted: 2021-06-03
Get Citation

“To do or not to do — that is the question”. Transvascular needle aspiration during EBUS (EBUS-TVNA) with review of the literature

Arvind M Perathur1, Tinku Joseph1, Sreeraj R Nair1, Umesh Varma1
DOI: 10.5603/ARM.a2021.0074
·
Pubmed: 34494242
·
Adv Respir Med 2021;89(4):386-391.
Affiliations
  1. Amrita Vishwa Vidyapeetham, Amrita Institute of Medical Sciences, Kochi, Kerala, India

open access

Vol 89, No 4 (2021)
ORIGINAL PAPERS
Published online: 2021-09-02
Submitted: 2021-03-13
Accepted: 2021-06-03

Abstract

Introduction: Large vessels are often encountered during endobronchial ultrasound (EBUS). Safety of traversing the vessels weighed against a more invasive procedure can be a dilemma.
Material and methods: We describe a case series of 8 patients who underwent transvascular needle aspiration during EBUS, to access a lesion in the absence of an alternate safe window. A 21 gauge EBUS needle was used to traverse either the main or a major branch of the pulmonary artery.
Results: Malignancy was suspected at ROSE in five cases. Granuloma and necrosis noted in 2 cases were confirmed as tubercu-losis on culture. Diagnostic yield of EBUS-TVNA was 87.5% (7/8). No complications were noted in the immediate post-operative period as well as during 6 months of follow up.
Conclusion: EBUS-TVNA in carefully selected patients is a feasible alternative to more invasive procedures with excellent yield. Appropriate intraoperative, perioperative and postoperative monitoring and care must be available in the case of fatal bleeds.

Abstract

Introduction: Large vessels are often encountered during endobronchial ultrasound (EBUS). Safety of traversing the vessels weighed against a more invasive procedure can be a dilemma.
Material and methods: We describe a case series of 8 patients who underwent transvascular needle aspiration during EBUS, to access a lesion in the absence of an alternate safe window. A 21 gauge EBUS needle was used to traverse either the main or a major branch of the pulmonary artery.
Results: Malignancy was suspected at ROSE in five cases. Granuloma and necrosis noted in 2 cases were confirmed as tubercu-losis on culture. Diagnostic yield of EBUS-TVNA was 87.5% (7/8). No complications were noted in the immediate post-operative period as well as during 6 months of follow up.
Conclusion: EBUS-TVNA in carefully selected patients is a feasible alternative to more invasive procedures with excellent yield. Appropriate intraoperative, perioperative and postoperative monitoring and care must be available in the case of fatal bleeds.

Get Citation

Keywords

EBUS, transvascular, TVNA, transvascular needle aspiration, transvascular biopsy

About this article
Title

“To do or not to do — that is the question”. Transvascular needle aspiration during EBUS (EBUS-TVNA) with review of the literature

Journal

Advances in Respiratory Medicine

Issue

Vol 89, No 4 (2021)

Article type

Research paper

Pages

386-391

Published online

2021-09-02

DOI

10.5603/ARM.a2021.0074

Pubmed

34494242

Bibliographic record

Adv Respir Med 2021;89(4):386-391.

Keywords

EBUS
transvascular
TVNA
transvascular needle aspiration
transvascular biopsy

Authors

Arvind M Perathur
Tinku Joseph
Sreeraj R Nair
Umesh Varma

References (15)
  1. Detterbeck FC, Postmus PE, Tanoue LT. The stage classification of lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013; 143(5 Suppl): e191S–e210S.
  2. Detterbeck FC, Boffa DJ, Kim AW, et al. The eighth edition lung cancer stage classification. Chest. 2017; 151(1): 193–203.
  3. Ortakoylu MG, Iliaz S, Bahadir A, et al. Diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration in various lung diseases. J Bras Pneumol. 2015; 41(5): 410–414.
  4. Jalil BA, Yasufuku K, Khan AM. Uses, limitations, and complications of endobronchial ultrasound. Proc (Bayl Univ Med Cent). 2015; 28(3): 325–330.
  5. Miller DR, Mydin HH, Marshall ADL, et al. Fatal haemorrhage following endobronchial ultrasound-transbronchial needle aspiration: an unfortunate first. QJM. 2013; 106(3): 295–296.
  6. King C, Rendo M, Kruse B, et al. Near fatal hemomediastinum with hemopneumothorax following endobronchial ultrasound-guided biopsy. Chest. 2019; 156(4): A1507–A1508.
  7. Kazakov J, Hegde P, Tahiri M, et al. Endobronchial and endoscopic ultrasound-guided transvascular biopsy of mediastinal, hilar, and lung lesions. Ann Thorac Surg. 2017; 103(3): 951–955.
  8. Folch E, Santacruz JF, Fernandez-Bussy S, et al. The feasibility of EBUS-guided TBNA through the pulmonary artery in highly selected patients. J Bronchology Interv Pulmonol. 2016; 23(1): 7–13.
  9. Boujaoude Z, Pratter M, Abouzgheib W. Transpulmonary artery needle aspiration of hilar masses with endobronchial ultrasound: a necessary evil. J Bronchology Interv Pulmonol. 2013; 20(4): 349–351.
  10. Panchabhai TS, Machuzak MS, Sethi S, et al. Endobronchial ultrasound-guided transvascular needle aspiration: A single-center experience. J Bronchology Interv Pulmonol. 2015; 22(4): 306–311.
  11. Mehta RM, Biraris PR, Pattabhiraman V, et al. Defining expanded areas in EBUS sampling: EBUS guided trans- and intra-pulmonary artery needle aspiration, with review of transvascular EBUS. Clin Respir J. 2018; 12(5): 1958–1963.
  12. Eapen GA, Shah AM, Lei X, et al. American College of Chest Physicians Quality Improvement Registry, Education, and Evaluation (AQuIRE) Participants. Complications, consequences, and practice patterns of endobronchial ultrasound-guided transbronchial needle aspiration: Results of the AQuIRE registry. Chest. 2013; 143(4): 1044–1053.
  13. Radner S. Suprasternal puncture of the pulmonary artery. Acta Med Scand. 1954; 148(2): 161–164.
  14. Naaman R, Sheikh A, Diab K. The feasibility of transvascular endobronchial ultrasound-guided transbronchial needle aspiration: a single tertiary-care center experience with 35 patients. Chest. 2020; 158(4): A1953.
  15. Harris K, Modi K, Kumar A, et al. Endobronchial ultrasound-guided transbronchial needle aspiration of pulmonary artery tumors: A systematic review (with video). Endosc Ultrasound. 2015; 4(3): 191–197.

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

Czasopismo Pneumonologia i Alergologia Polska dostęne jest również w Ikamed - księgarnia medyczna

Wydawcą serwisu jest "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl