Percutaneous bronchial artery embolization in the management of massive hemoptysis in chronic lung diseases. Immediate and long-term outcomes.
OBJECTIVE
Bronchial artery embolization (BAE) is a well-established, non-surgical procedure in the emergency treatment of massive hemoptysis. This study aims to evaluate the immediate and long-term prognosis of BAE for the management of massive hemoptysis in our center.


METHODS
Twenty consecutive patients (mean age: 59+/-14 years) with massive hemoptysis, underwent BAE with microspheres (Embospheres BioSphere Medical SA, Paris, France), polyvinyl alcohol particles (PVA, Ivalon, Cathmed Science; Paris, France) or/and steel coils (Cook, Denmark) after thoracic aortography and diagnostic selective and superselective catheterization of bronchial arteries and systemic collateral vessels in the bleeding lung area. Hemoptysis was due to bronchiectasis (55%), non-operable aspergillomas (15%), active tuberculosis (15%), malignancy (10%) and cystic fibrosis (5%). Mean duration of follow-up was 29+/-18 months. The recurrent-free time was calculated with Kaplan-Meier analysis.


RESULTS
Immediate control of bleeding was achieved in all patients. Recurrent cases of hemoptysis were observed in 6/20 patients (30%) within 3 years and 4 of them (66.6%) occurred early in the first 3 months. Recurrent-free time was 9 months (standard error: 4) (95% confidence interval: 0-17). Repeated interventions were required in all early recurrences, due to either recanalization of the occluded arteries or non-bronchial systemic artery supply. Combined use of PVA and coils was proved effective in these cases. No serious complications were observed.


CONCLUSIONS
BAE is an effective and safe intervention in cases of massive hemoptysis. However, recurrences are common and long-term follow-up is considered important with a view to perform repeated interventions with combination of embolic materials.
Serasli
E
E
2nd Chest Department, G. Papanikolaou General Hospital, Thessaloniki, Greece. serasli@patsialas.gr
Kalpakidis
V
V
Iatrou
K
K
Tsara
V
V
Siopi
D
D
Christaki
P
P
D000180:Acrylic Resins / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001981:Bronchial Arteries / Q000000981:diagnostic imaging; D002908:Chronic Disease; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D005780:Gelatin / Q000627:therapeutic use; D006469:Hemoptysis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008171:Lung Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011145:Polyvinyls / Q000627:therapeutic use; D011446:Prospective Studies; D015641:Radiography, Interventional; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome
D000180:Acrylic Resins; D011145:Polyvinyls; C026699:ivalon sponge; C496735:trisacryl gelatin microspheres; D005780:Gelatin