Custom Silicone Bronchial Occluders Stop Refractory Hemoptysis in Small Case Series

When a patient coughs up blood and nothing seems to stop it, the options narrow quickly. Hemostatic drugs may fail, and arterial embolization—the standard interventional rescue—can be impossible when no suitable culprit vessel can be found or when bleeding returns after the procedure. A new retrospective case series published in BMC Pulmonary Medicine describes an alternative salvage approach: bronchoscopically implanted, custom-made sutured silicone bronchial occluders that physically isolate the bleeding segmental airway.

The study enrolled four consecutive patients with refractory hemoptysis whose bleeding persisted despite hemostatic medication at a single center. Two of the four had already undergone arterial embolization attempts: one received pulmonary artery embolization but bled again within a month, while selective arteriography in another failed to achieve embolization. In the remaining two patients, selective angiography identified no embolizable culprit vessel at all. The underlying causes of bleeding included a lung cancer cavity, an aortic malformation complicated by a bronchial fistula, and a diaphragmatic arterial bronchial fistula.

The technical logic behind the device is straightforward. Before surgery, each patient underwent enhanced chest CT to pinpoint the exact segmental bronchus responsible for the bleeding and to measure its diameter. The occluders were then individually tailored from medical silicone and shaped into cones, with non-absorbable sutures used to reinforce their structure. The base diameter of each occluder was deliberately made 15 to 20 percent larger than the measured target bronchial diameter, ensuring a friction fit that holds the device in place without additional anchoring.

Implantation was performed under general anesthesia. A rigid bronchoscope, or in some cases a laryngeal mask, was used to establish airway access.

The results, while drawn from a very small sample, were consistent across all four patients. Every procedure was completed successfully without severe airway injury. On bronchoscopy performed immediately after implantation, active bleeding was no longer visible in any case. Complete clinical cessation of hemoptysis, including clearance of residual blood, occurred within 24 to 36 hours in all patients.

Follow-up extended to 12 months, with assessments at 3, 6, and 12 months. No recurrence of hemoptysis was observed at any of these intervals. Safety findings were similarly limited: only one patient developed a low-grade fever, peaking at 38.1 degrees Celsius, within 24 hours of surgery, which resolved with symptomatic management. There were no instances of occluder displacement, airway obstruction, aggravated infection, or other severe complications during the observation period.

The authors are explicit about the limits of what these findings show. Given the sample size of four and the absence of objective pulmonary function testing or validated quality-of-life instruments, the study makes no claims about preserving lung function or improving quality of life. The conclusions are framed as preliminary evidence from a small, single-center, retrospective feasibility case series, positioned as a potential palliative salvage option for carefully selected patients with refractory but relatively controlled segmental hemoptysis in whom medication failed and embolization was unsuccessful or not feasible.

That framing matters. The authors state that these findings do not establish superiority over bronchial artery embolization, surgery, or commercially available endobronchial occlusive devices—the established arms of hemoptysis management. What the series does offer is a proof of concept: that a conical silicone occluder, custom-shaped and suture-reinforced to match a measured airway diameter, can be placed bronchoscopically to isolate a bleeding segment and hold its position long enough for bleeding to stop, with no recurrence over a year of follow-up in this handful of patients.

Subject of Research: Bronchoscopic placement of custom-made sutured silicone bronchial occluders as a palliative treatment for refractory segmental hemoptysis

Article Title: Bronchoscopic placement of custom-made sutured silicone bronchial occluders for refractory hemoptysis: a retrospective case series

Article References: Gao, T., He, X., & Li, J. (2026). Bronchoscopic placement of custom-made sutured silicone bronchial occluders for refractory hemoptysis: a retrospective case series. BMC Pulmonary Medicine. https://doi.org/10.1186/s12890-026-04922-8

Image Credits: AI Generated

DOI: 10.1186/s12890-026-04922-8

Keywords: hemoptysis, bronchoscopy, bronchial occluder, silicone occluder, airway isolation, arterial embolization, interventional pulmonology, case series, BMC Pulmonary Medicine, bronchial fistula, lung cancer, Bronchoscopic