Bronchial and Nonbronchial Systemic Artery Embolization: Experience With 348 Patients

Abstract

PURPOSE: To report Assiut experience with bronchial arteriography and bronchial artery embolization (BAE) in the management of moderate recurrent or life threatening hemoptysis. METHOD(S): A review of clinical experience to evaluate the demographics, clinical presentation, radiographic studies, short term efficacy, long term efficacy and complications of bronchial arteriography with or without BAE, in Assiut university hospital, from 1998 to 2009. RESULT(S): Out of 348 patients presented with moderate recurrent or life-threatening hemoptysis, BAE was performed in 341 patients. Their mean age was 45+/-18 years. Active or inactive pulmonary tuberculosis was the most common etiology responsible for hemoptysis in our locality followed by bronchiectasis and other identified etiologies, while cryptogenic hemoptysis was recorded in 5 cases. The most common angiographic sign for hemoptysis was hypervascularity, followed by systemic-pulmonary artery shunt, while, the least common one was pulmonary artery aneurysm. It was noticed that all cases with systemic-pulmonary shunt showed a sharp cut-down of pulmonary arterial blood flow, on the affected side, with retrograde filling of pulmonary artery from systemic arteries. Bronchial arteries were the main source of hemoptysis followed by intercostal and intercostobronchial arteries, while, pulmonary arteries were responsible for hemoptysis in a minority of cases. BAE was effective in immediate and long term control of hemoptysis in 82%. Recurrence of hemoptysis was observed in 18% and reimbolization was indicated in 12%. More than one setting of BAE were performed in 42% either due to recurrence of hemoptysis or to complete the embolization procedure for multiple bleeding arteries. Complications of BAE were in the form of self-limited acute and subacute complications, while chronic complications were not recorded during the course of this study. CONCLUSION(S): BAE is an effective therapeutic line for short and long term control of lifethreatening or moderate recurrent hemoptysis and its complications are usually self-limited and often do not need specific intervention. CLINICAL IMPLICATIONS: BAE should be considered for control of life-threatening or moderate recurrent hemoptysis. BAE is a safe and effective procedure.