Bronchial Artery Embolisation for Massive Haemoptysis: Immediate and Long-Term Outcomes—A Retrospective Study

Abstract

Introduction: Bronchial artery embolisation (BAE) is an established treatment method for massive haemoptysis. The aim of this study is to evaluate the impact of BAE on in-hospital outcomes and long-term survival in patients with massive haemoptysis. Methods: Retrospective review of all cases of acute massive haemoptysis treated by BAE between April 2000 and April 2012 with at least a 5 year follow up of each patient. Targeted BAE was performed in cases with lateralising symptoms, bronchoscopic sites of bleeding or angiographic unilateral abnormal vasculature. In the absence of lateralising symptoms or signs, bilateral BAE was performed. Results: 96 BAEs were performed in 68 patients. The majority (64 cases, 67%) underwent unilateral procedures. 83 (86.5%) procedures resulted in immediate/short term control of haemoptysis which lasted for longer than a month. The mean duration of haemoptysis free period after embolisation was 96 months. There were three major complications (cardio-pulmonary arrest, paraparesis and stroke). 38 (56%) patients were still alive at least 5 years following their BAE. Benign causes were associated with significantly longer haemoptysis free periods, mean survival 108 months compared to 32 months in patients with an underlying malignant cause (p = 0.005). An episode of haemoptysis within a month of the initial embolisation was associated reduced overall survival (p = 0.033). Conclusion: BAE is effective in controlling massive haemoptysis. Long-term survival depends on the underlying pulmonary pathology. Strategies are required to avoid incomplete initial embolisation, which is associated with ongoing haemoptysis and high mortality despite further BAE.

Clinical significance of interventional therapeutic bronchoscopy combined with bronchial arterial embolization in the treatment of hypervascular primary airway tumors in children

“…Bronchial artery embolization is a vascular interventional therapy that was developed on the basis of selective tracheal intubation and angiography. An embolic agent is selectively injected into the bronchial artery through the catheter, thereby blocking diseased blood vessels such as malformed and dilated vessels, and its immediate hemostatic effect is good 10‐12 . Therefore, for hypervascular tumors in the large airway, it is better to first embolize the bronchial artery under local anesthesia.…”

CIRSE Standards of Practice on Bronchial Artery Embolisation

“…When large pulmonary arterial or venous shunts are present, larger sized tris-acryl microspheres (700–900 μm) or coil embolisation may help avoid complications [ 14 , 31 , 32 ] such as pulmonary, myocardial, or systemic infarcts [ 13 , 32 ]; the presence of spinal cord feeders arising from the bronchial artery also seems to be less critical when using larger sized (700–900 μm) particles [ 19 , 27 ].…”

“…The prevailing view of using microcoils for BAE is that coil embolisation would prevent future BAE for recurrent haemoptysis due to proximal embolisation and the development of challenging collateral vessels [ 14 , 22 , 36 ]. However, high-packing-density coil deployment, using hydrogel-polymer-coated or high thrombogenic coils may be still used in recurrent haemoptysis [ 37 ] to protect spinal supply [ 31 ] and distal circulation, to occlude actively bleeding vessels as in pseudoaneurysms, or to occlude large bronchial-to-pulmonary shunts [ 3 , 5 ].…”

“…As long as no immediate intervention is necessary such as in life-threatening haemoptysis, clotting parameters and haemodynamic status will be optimised prior to intervention [ 31 ] and fasting of 3–6 h (depending on local protocol and type of sedation/anaesthesia) is recommended in elective cases to prevent aspiration.…”

“…Antifibrinolytics (aminocaproic acid, or tranexamic acid) may be helpful in minor recurrent haemoptysis [ 1 , 15 , 31 , 43 ]; however, there is too little evidence to judge whether any antifibrinolytics should be used to treat haemoptysis [ 43 ].…”