Abstract
<title>Abstract</title> <p> <bold>Background</bold> Refractory tracheal hemoptysis remains difficult to control when conventional hemostatic medication and bronchial artery embolization fail. This study explored the clinical efficacy and safety of bronchoscopic placement of custom-made sutured silicone prostheses as a minimally invasive salvage option. <bold>Methods</bold> A total of 4 patients with refractory tracheal hemoptysis who did not respond to hemostatic medications and arterial embolization were retrospectively enrolled. The underlying causes included lung cancer cavity, aortic malformation complicated with tracheal fistula, and diaphragmatic arterial tracheal fistula. Preoperative enhanced chest CT was performed to accurately localize the bleeding segmental bronchus. Under general anesthesia, rigid or flexible bronchoscopy was applied for intraoperative exploration. Conical artificial occlusive prostheses were individually tailored and sutured with medical silicone materials, then precisely implanted via bronchoscopy to occlude the bleeding bronchus. All patients received standardized antitussive treatment postoperatively and were followed up for 12 months. The hemostatic effect, pulmonary function tolerance and incidence of complications were evaluated. <bold>Results</bold> All 4 patients underwent successful operation without severe airway injury during the procedure. Hemoptysis was completely resolved within 24 to 36 hours after prosthesis placement. 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 hours after surgery, which was relieved after symptomatic management. No prosthesis displacement, airway obstruction, aggravated infection or other severe complications occurred. The ventilatory function of all patients was basically unaffected, and their quality of life was significantly improved. <bold>Conclusions</bold> Bronchoscopic placement of custom-made sutured silicone prostheses yielded reliable immediate hemostasis, no recurrence during 12-month follow-up and a favorable safety profile in this small retrospective case series. This technique may serve as a salvage therapy for selected patients with refractory tracheal hemoptysis after failure of medication and arterial embolization. Clinical trial number: not applicable. </p>