Percutaneous embolotherapy for life-threatening hemoptysis.
OBJECTIVE
The management of life-threatening hemoptysis frequently poses a therapeutic dilemma because such patients are often poor surgical risks. Less often, patients refuse surgical intervention. The value of percutaneous embolotherapy, a useful alternative in these situations, was assessed.


METHODS
Sixteen consecutive patients who underwent percutaneous embolotherapy for life-threatening hemoptysis in a tertiary-care hospital were evaluated retrospectively. The bronchial arteries, as well as other intrathoracic arteries, were evaluated and selectively embolized if they were considered to supply the pathologic area from which the hemoptysis arose.


RESULTS
The most common cause for hemoptysis was posttuberculous bronchiectasis (n = 12) with or without mycetomas. Ten patients required blood transfusions before embolotherapy. Pleural disease was noted on the chest radiograph in 13 patients and was generally associated with the presence of nonbronchial systemic collateral vessels. In three patients, arteries other than the bronchial arteries were the only source of hemoptysis. Percutaneous embolotherapy was successful in controlling the hemoptysis in all patients. The only complication documented was a transient paraparesis in one patient. Six patients did not return for follow-up. Of the remaining 10 patients, 3 patients had minor episodes of hemoptysis that were treated conservatively with success. One patient had significant recurrent hemoptysis that was managed with radiotherapy. One patient subsequently underwent a lobectomy.


CONCLUSIONS
Percutaneous embolotherapy is a useful therapeutic modality in the management of life-threatening hemoptysis. The contribution of nonbronchial systemic collateral vessels, particularly where there is evidence of coexistent pleural disease, should always be suspected. In experienced hands, this is a safe and potentially life-saving procedure.
Wong
Michelle L
ML
Respiratory Unit, Department of Medicine, Chris Hani Baragwanath Hospital, and the University of the Witwatersrand, Johannesburg, South Africa. 014miche@chiron.wits.ac.za
Szkup
Peter
P
Hopley
Mark J
MJ
D000328:Adult; D000368:Aged; D000792:Angiography; D001981:Bronchial Arteries / Q000000981:diagnostic imaging; D001987:Bronchiectasis / Q000150:complications / Q000000981:diagnostic imaging; D004621:Embolization, Therapeutic; D005260:Female; D006469:Hemoptysis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013895:Thoracic Arteries / Q000000981:diagnostic imaging; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000000981:diagnostic imaging