Management of massive hemoptysis by bronchial artery embolization.

Abstract

Massive hemoptysis is a major clinical and surgical problem with a mortality of 80%, which is most often related to asphyxiation. Thirty-three patients with massive hemoptysis underwent selective bronchial arteriography and treatment by embolization or surgery. Lasting control of hemoptysis was achieved in 27 of 33 patients (81.8%) at follow-up ranging from one to 24 months. Hemoptysis recurred in six of 33 patients (18.2%). Mortality related to hemoptysis was three of 33 patients (9.0%), and overall mortality was six of 33 patients (18.2%). Seven patients underwent surgical treatment in addition to bronchial artery embolization. Patients with mycetoma suffered the highest relapse of bleeding and the highest mortality in this series. In these patients, bronchial artery embolization may be effective in the control of acute bleeding, but permanent control of hemoptysis is achieved only by later surgery. Bronchial artery embolization is an effective way to control massive hemoptysis with a low recurrence rate and reduced mortality among severely ill patients. Although we have had no unfavorable sequelae, reports of neurological damage following bronchial angiography indicate care in avoiding obstruction of the artery of Adamkiewicz.

Bronchial Arteriography and Transcatheter Embolization in Management of Severe Haemoptysis

“…In view of considerable hypervascularity, these lesions require extensive embolization of abnor- Table 4 Cause of baemoptysis and immediate effect of BAE mal bronchial and non bronchial systemic vessels for complete haemostasis. Most of these lesions, however, bleed if not treated surgically (6]. In our study, irnmediate success occurred in 97.7%.…”

“…Any massive episode of bleeding threatens to cause acute asphyxiation, especially to those patients with impaired pulmonary function. Surgery during acute massive haemoptysis has a high mortality and complication rate [6]. Bronchial artery embolization is an effective method to control haemoptysis not controlled with conservative management especially in patients with chronic pulmonary diseases, who are not suitable candi$tes for surgical resection.…”

“…However in view of smaller number of cases with PVA embolization it cannot be considered significant as yet. Particles less than 200 mJ.l have been shown to cause bronchial necrosis and death [6].We used gel foam pellets 2-3 mm in size and PVA particles more than 500 J.l in size.…”

“…males),their ages ranged from 22 to 62 years and averaged 29. 6 years. The underlying causes included Tuberculosis (0=37), Tuberculosis with Aspergilloma (n=4) and Bronchiectasis (n=4) (Table I).…”

“…Previous reports have stressed that transcatheter embolization is only a temporary measure [6] and its long term effects have not been sufficiently recognised. Here we report a prospective study of 45 patients with severe haemoptysis treated by bronchial artery embolization (BAE) in our institution from September 1995 to March 1998.…”