Preemptive non-selective bronchial artery angioembolization to reduce recurrence rate of hemoptysis

Abstract

Background: Massive hemoptysis which is presented in advanced lung diseases is a life-threatening condition. Bronchial artery embolization as a minimally invasive procedure is the treatment of choice either in first or recurrent hemoptysis. This study aimed to assess the early and late efficacy of bronchial angioembolization (BAE) without microcatheter.Methods: In this prospective cohort study, all patients with hemoptysis who had undergone BAE from August 2018 to March 2019 were included. Angiographic patterns including bleeding sources, number of involved vessels, the underlying etiology, and recurrence rate were evaluated in a one-year follow-up.Results: 153 patients were included with mean age of 55 ±16 years. 68% of them were male and 58% had life-threatening massive hemoptysis. Three distinct angiographic patterns were recognized. The culprit bleeding vessel was bronchial in 126 (92%), intercostal in 4 (3%), and both vessels in 7 (5%) of cases (P<0.05). One vessel involvement was seen in 56 patients; however it was observed in 69% of non-cystic fibrosis lobar bronchiectasis patients. In 1, 3 and 12 months follow up, recurrent hemoptysis was reported in 15 (11%), 4 (2.5%), and 24 (15.5%), respectively. In 52% of cases, no abnormal vessels were observed during aorta injection, but culprit bronchial or intercostal arteries were found in selective investigational angiography.Conclusion: BAE was successful in the control of hemoptysis and resulted in a low rate of recurrence in different types of lung diseases. This could be due to the embolization of all pathological arteries found during angiography which might have prevented recurrent bleeding.

Which Is the Best Way to Treat Massive Hemoptysis? A Systematic Review and Meta-Analysis of Observational Studies

“…A proportional meta-analysis was performed for all studies that used a common mode of management of massive hemoptysis, that is, BAE, and provided relevant data [45][46][47][48][49][50][51][52][53][54]56,57,[59][60][61][62][63][64]66,[68][69][70][71][72]74].…”

“…In this systematic review, 30 studies related to the management of massive hemoptysis were included, of which 26 used bronchial artery embolization as a management method [45][46][47][48][49][50][51][52][53][54]56,57,[59][60][61][62][63][64][66][67][68][69][70][71][72]74]. The 30 studies were observational retrospective cohort studies.…”

“…In these cases, surgical treatment of hemoptysis should be discussed to reduce the risk of rebleeding. Many times, during follow-up, the need for re-interventions can be seen [45][46][47][48][49][50][51][52][53][54]56,57,[59][60][61][62][63][64][66][67][68][69][70][71][72]74].…”

Chest-Wall Collateral Embolization to Reduce Surgical Blood Loss in Peripheral Aspergillomas

“…We did not rely on aortography or proximal subclavian artery runs because these may underestimate the collateral supply; rather selective runs of individual arteries expected to be abnormal were taken. 28,29 Renal double curve 5F catheter (Cook Medical, United States) was commonly used to hook intercostal arteries. In case of any difficulty, Cobra (complex curve) or Simmons (reverse curve) catheter (Cook Medical, United States) was used.…”

Bronchial Artery Embolization for Life-Threatening Hemoptysis in COVID-19 Patients

“…9 Aspergillosis is one of the most common causes of massive hemoptysis in developed countries. 10 Clinically, aggressive pulmonary aspergillosis presents as acute non-specific pneumonia with cough, chest pain, and fever and can become life-threatening with the occurrence of massive hemoptysis. 11 In the case of massive hemoptysis, emergency treatment of the underlying cause can be life-saving.…”