title: Bronchial artery embolization for massive hemoptysis: long-term follow-up.
abstract: OBJECTIVE
  Bronchial artery angiography with embolization has become a mainstay in the treatment of massive hemoptysis. Whereas the immediate success rate is high, the reported long-term success rate varies widely among different groups. We aimed to explore the long-term outcome and clinical predictors associated with recurrent bleeding following bronchial artery embolization.
  
  
  METHODS
  We reviewed the clinical characteristics, underlying etiologies, procedure details, and outcome of bronchial artery embolization performed for massive hemoptysis between 1999 and 2012.
  
  
  RESULTS
  All 52 consecutive patients treated by bronchial artery embolization during the study period were included. The major etiologies of massive hemoptysis were bronchiectasis (mostly post-infectious) in 53.8%, and primary and metastatic lung cancer in 30.8%. The immediate success rate was high (48/52; 92%). Of 45 patients who survived more than 24 hours following bronchial artery embolization, recurrent bleeding did not occur in 19 (42.2%) during a median follow-up period of 60 months (range 6-130 months). Bleeding recurred in 26 (57.7%); within 30 days in 15 (33.3%) and after 1 month in the other 11 (24.4%). The average time to onset of early and late repeat bleeding was 2 and 506 days, respectively. Idiopathic bronchiectasis and lung cancer were associated with a high likelihood of late bleeding recurrence.
  
  
  CONCLUSIONS
  Bronchial artery embolization is an effective immediate treatment for massive hemoptysis. Because the bleeding recurrence rate is high in patients with lung cancer or idiopathic bronchiectasis, surgery should be considered in these patients following initial stabilization by bronchial artery embolization. For other underlying etiologies, the long-term outcome is excellent.
authors: The Pulmonary Institute, Rabin Medical Center, Petah Tiqwa, Israel Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel orenfr@clalit.org.il.
authors: Oren
authors: O
authors: Fruchter
authors: The Pulmonary Institute, Rabin Medical Center, Petah Tiqwa, Israel Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: Sonia
authors: S
authors: Schneer
authors: The Pulmonary Institute, Rabin Medical Center, Petah Tiqwa, Israel Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: Victoria
authors: V
authors: Rusanov
authors: Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel Department of Interventional Radiology, Rabin Medical Center, Petah Tiqwa, Israel.
authors: Alexander
authors: A
authors: Belenky
authors: The Pulmonary Institute, Rabin Medical Center, Petah Tiqwa, Israel Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: Mordechai R
authors: MR
authors: Kramer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001981:Bronchial Arteries / Q000000981:diagnostic imaging; D001987:Bronchiectasis / Q000150:complications; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005260:Female; D006469:Hemoptysis / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007557:Israel; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000150:complications; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
keywords: Angiography; bronchial arteries; embolization; hemoptysis; lung diseases; lung neoplasms; therapeutic