Embolization of the systemic arteries of the lung

Immediate and long-term results of bronchial artery embolization for life-threatening hemoptysis

STUDY OBJECTIVES

Bronchial artery embolization (BAE) has been established as an effective technique in the emergency treatment of life-threatening hemoptysis, but few data concerning long-term results and complications of the procedure are available. The aim of this study was to analyze retrospectively the experience of BAE in our center with particular emphasis on medium-term and long-term results and on morbidity.

SETTING

University hospital.

PATIENTS

Fifty-six patients underwent bronchial arteriography from 1986 to 1996 in our center for the management of life-threatening hemoptysis. Of them, BAE was performed in 46 patients. Their mean age was 51 years (range, 19 to 89 years). The most frequent etiologies of hemoptysis were active or inactive tuberculosis, bronchiectasis, or idiopathic hemoptysis.

RESULTS

BAE resulted in an immediate cessation of hemoptysis in 43 of the initial 56 patients (77%). During the first month after BAE, four patients who died from causes other than hemoptysis or who were referred to surgery were excluded from follow-up and in the 39 remaining patients, a complete cessation of hemoptysis was observed in 32 patients. A remission was noted in 28 of the 29 patients followed up between 30 and 90 days after BAE. Long-term control of bleeding was achieved in 25 of the initial 56 patients (45%) followed up beyond 3 months after BAE (median follow-up of 13 months; range, 3 to 76 months). Overall, complications of BAE consisted of two episodes of mediastinal hematoma and three episodes of neurologic damage, two of which improved without permanent sequelae.

CONCLUSION

We conclude that BAE may result in long-term as well as immediate control of life-threatening hemoptysis but that complications are not unusual.

[Bronchial embolization in the treatment of hemoptysis]

The aim of this retrospective study was to evaluate the efficacy of bronchial artery embolization to treat hemoptysis. Eight hundred sixty-five patients were admitted to our hospital with hemoptysis during the study period. Bronchial arteriographs were obtained for 48, who suffered life-threatening hemoptysis refractory to medical treatment. The likely origin of bleeding was identified in 37: embolization was performed with particles measuring 250 to 1000 micra in size (Contour Emboli, Interventional Therapeutic Corporation, South San Francisco, California, USA) in 35 and with hemostatic collagen sponges in 2. The most common causes of hemoptysis were bronchiectasis (40%), pulmonary tuberculosis (33%), pulmonary aspergilloma (8%) and malignant neoplasm (8%), chronic bronchitis (6%); 4% of the cases were idiopathic. Immediate technical success was achieved in 34 patients (92%) as defined by the absence of hemorrhage for at least 24 hours. All embolized patients were followed until the first recurrence of bleeding or until discharge. Recurrence of hemoptysis (in the first month) was early in 5 patients (13.5%) and late (2 to 96 months) in 9 (24%). The severity of the initial and later episodes of hemoptysis was similar in all early recurrences and most late recurrences. A second embolization was performed six times, and medical and/or surgical treatment was given in all other cases. No significant complications attributable to the technique were observed. The results show that bronchial embolization is valid for the immediate control of life-threatening hemoptysis and has a low rate of severe complication; recurrence is relatively common.

Embolotherapy for persistent hemoptysis: the significance of pleural thickening

Elective embolotherapy for recurrent hemoptysis was evaluated for its effectiveness. Forty embolotherapeutic procedures were performed in 30 patients. In the short term, complete hemostasis was achieved in 16 of 40 procedures (40%) and significant improvement in another 16 procedures (40%). Long-term, complete hemostasis was achieved in 14 of 34 procedures (41%) and significant improvement in 12 (35%). Embolotherapy was consistently more effective in patients who had no pleural abnormalities compared with those with pleural thickening. Long-term complete hemostasis was achieved in 7 of 10 procedures (70%) for the patients without pleural thickening and only 7 of 24 (29%) in patients with pleural thickening. Thus, pleural abnormalities negatively influence long-term effectiveness of embolotherapy.