Bronchial artery embolization for massive hemoptysis.

ABSTRACT

Hemoptysis, when massive and untreated, has a mortality rate of more than 50%. Therefore, significant hemoptysis calls for swift detection of the anatomic source of the hemorrhage so that definite therapy can be initiated to stop bleeding. Bronchoscopy, chest roengenography and CT scans may point to the likely source of the hemorrhage. Since the bronchial circulation is the major source of hemoptysis, therapeutic embolization of bronchial arteries can be performed to stop bleeding. Angiographic and clinical data from 30 patients (35 sessions) with hemoptysis who were referred for embolotherapy between 1998-2002 were retrospectively reviewed. The most frequent causes of hemoptysis were tuberculosis (66%), bronchiectasis (11%) and other various conditions resulting in bronchpulmonary anastomoses (11%). The bronchial embolization was attempted in 27/35 sessions with percentage grading successful rate of embolization. Recurrent hemoptysis could be as high as 100% if the initial embolization success rate was less than 50%. Overall, 14/27 patients suffered a bleeding relapse. Note that nine of these patients experienced a bleeding relapse within 30 days, whereas the rest occurred more than 30 days after embolization. Note that, repeat embolization can be performed safely.