Bronchial Artery Embolization for Hemoptysis

Abstract

Bronchial artery angiography with embolization has become a mainstay in the treatment of hemoptysis. Major complications are rare and immediate clinical success defined as cessation of hemorrhage ranges in most series from 85% to 100%, although recurrence of hemorrhage ranges from 10% to 33%. Bronchial artery embolization offers a minimally invasive procedure for even the most compromised patient serving as first-line treatment for hemorrhage as well as providing a bridge to more definitive medical or surgical intervention focused upon the etiology of the hemorrhage. The aim of this article is to summarize the etiologies, pathophysiology, and the diagnostic and management strategies of hemoptysis as related to bronchial artery embolization. In addition, the techniques of arteriography and embolization as well as associated procedural outcomes and complications are delineated.

Bronchial artery embolization in hemoptysis: a systematic review

“…These figures were lower than those reported previously in older reviews and in studies with less than 50 patients (2,3). This can be attributable to the greater expertise and experience of the authors of larger studies.…”

“…Thus, there was no significant decrease in hemoptysis recurrence rate despite availability of improved hardware and permanent and more durable embolizing agents. This is not surprising as BAE essentially remains a palliative procedure to manage hemoptysis in patients with diffuse or bilateral lung disease or poor pulmonary reserve who are otherwise unfit to undergo surgery (3,16).…”

Radiological Evaluation of Hemoptysis

“…Çoğu zaman parankimal kronik pulmoner hastalıklara eşlik ederler. Plevrayı penetre ettikleri alanda plevrada 3 mm'yi aşan kalınlaşma ve subplevral yağ planında belirgin kalınlaş-ma oluşturmaları varlıkları ile ilgili ipucu verir (7).…”

“…Masif hemoptizi 24 saat içerisinde 300 mL üzerinde kan ekspektore edilmesi demektir ve BAE için temel endikasyonu oluşturur (7). Elbette hemoptizide BAE endikasyonu çok kesin sınırlarla belirlenemez, hastanın akciğer kapasitesi, genel durumu ve hava yolunun açık tutulabilmesi gibi klinik kriterler değerlendirilerek endikasyon konmalıdır.…”

A Case of Tracheal Varices in an Adolescent Patient with Cyanotic Heart Disease

“…If bleeding is severe, a double-lumen endotracheal tube may be placed to permit ventilation of both lungs while preventing aspiration from one lung to another. Pulmonary angiography and embolization is used principally for bleeds involving high-pressure bronchial circulation, which accounts for most cases of massive hemoptysis (27,28). Laser therapy, electrocautery, argon plasma coagulation, or cryotherapy may be able to stop the bleeding if bronchoscopy identifies limited bleeding mucosal lesions.…”