Arterial Embolization for Management of Hemoptysis in Pulmonary Tuberculosis: Factors of Rebleeding

ABSTRACT

PURPOSE: To evaluate the effectiveness of arterial embolization in reducing hemoptysis in pulmonary tuberculosis, and rebleeding factors after embolization. MATERIALS AND METHODS: Fifty-nine patients with massiveor recurrent hemoptysis from pulmonary tuberculosis were underwent percutaneous transcatheter embolotherapy and thirteen were subsequentyly operated on. In 46 patients, we retrospectively analyzed on plain chest PA the extent of pulmonary tuberculosis lesions, the period from initial diagnosis to embolization, and angiographic findings. the extent of lesions shown on plain chest PA were classified into minimal, moderately advanced, and far advanced. If there was no evidence of rebleeding after the first embolization, this was regarded as initial success in thecontrol of hemoptysis. Angiographic findings were classified into hypervascularity, shunt, aneurysmal dilatation,and extravasation. Using the chi-square test, differences in these findings between rebleeding and non-rebleeding cases were analysed. RESULTS: Immediate control of hemoptysis was achieved in 27 (58.7%) of 46 patients. Hemoptysis recurred in 19 (41.3%) of 46 patients followed up. Rebleeding cases showed more nonbronchial systemiccollateral vessels and shunt than non-rebleeding cases (p<0.05). More advanced lesions of pulmonary tuberculosison plain chest PA showed an increased rebleeding rate after embolization, but this was not statistically significant There was no correlation between the period from initial diabnosis of pulmonary tuberculosis to embolization and the rate of rebleeding. But the longer the period, the greater the number of nonbronchial systemic collateral vessels. CONCLUSION: In cases with more advanced lesions of pulmonary tuberculosis on plainchest PA and a long period from initial diagnosis of pulmonary tuberculosis to embolization, angiographic findings showed numerous nonbronchial systemic collateral vessels but increases in the rebleeding rate were statistically not significant. The greater the number of nonbronchial systemic collateral vessels and shunt, the higher there bleeding rate after embolization.