Cryotherapy to Extract Obstructing Blood Clots

Abstract

To the Editor: We read with special interest the letter to the editor by Schummer and Schummer entitled “Hemorrhagic Tracheobronchial Obstruction,” which appeared in the July 2001 issue of Journal of Bronchology (J Bronchol 2001;8:236). This letter related the difficulties in removing blood clots through a flexible bronchoscope using a Fogarty catheter and a biopsy forceps. We agree with the authors that rigid bronchoscopy is the method of choice in the setting of tracheobronchial bleeding, and that in some critically ill patients, only flexible endoscopy may be used under local anesthesia. The authors asked if anyone knew of better tools that can be used during flexible bronchoscopy for the removal of blood clots from the tracheobronchial tree. We are able to propose cryotherapy as the best solution. This technique is now well-known in treating both benign and malignant tracheobronchial obstruction. 1–3 However, one of the main effects of cold is cryoadherence, which allows extraction times of a few seconds of different foreign bodies such as tablets, 4 food, and peanuts, but also extracts sloughs caused by previous cryotherapy and blood clots (Fig. 1 and 2). Recently, Mehta and Rafanan 5 presented available methods to extract foreign bodies, including cryotherapy. Flexible cryoprobes are available and pass through the operative channel of a flexible bronchoscope. The cryoadherence effect is generally used for the extraction of porous or friable structures, but this technique has been used with success in some cases to extract solid foreign bodies such as glass fragments. 6FIG. 1.: Extraction of a large clot from the bronchial tree under local anesthesia with a flexible bronchoscope and a flexible cryoprobe.FIG. 2.: The same clot unfolded demonstrates true molding of the bronchi of the right lower lobe.Jean-Paul Homasson, M.D. Jean-Michel Vergnon, M.D., Ph.D.