Management of hemoptysis with bronchial artery embolization: Benign versus malignant indications

Abstract

Objectives: The purpose of this study is to compare the role of bronchial artery embolization (BAE) in hemoptysis due to malignant and non-malignant etiologies. Material and Methods: Data from patients who underwent BAE at a tertiary care center from October 2002 to 2018 were retrospectively reviewed. Variables evaluated include procedural indication, technical success, clinical success, re-embolization, intensive care unit (ICU) admission, length of stay, and thirty-day readmission. Categorical and continuous variables were analyzed using Pearson’s Chi-squared and two sample t-tests, respectively. Post-procedure survival and re-embolization were analyzed using Kaplan–Meier curves and Cox proportional hazard models. Results: 114 BAE procedures from 93 unique patients with hemoptysis were identified, with 29.8% of procedures being performed for hemoptysis secondary to malignancy and 70.2% for benign causes. The technical and clinical success rates of the procedure were similar between benign and malignant etiologies (benign/malignant: 92.5% vs. 91.2% and 82.5% vs. 73.5%, respectively). There were no statistically significant differences in rates of need for re-embolization, ICU admission, 30-day readmission, mean hospital length of stay, or mortality between benign and malignant groups. Clinically successful embolization was protective against death (HR = 0.19, P < 0.001) and re-embolization (HR = 0.04, P = 0.001), while higher American Society of Anesthesiologists’ (ASA) score, female sex, and primary pulmonary malignancy were associated with risk of death. Conclusion: While patients with a malignant cause of hemoptysis had an increased risk of mortality and decreased survival time, BAE for malignant hemoptysis is effective with outcomes comparable to that for benign hemoptysis as indicated by high clinical and technical success rates and low rates of re-embolization.