Risk Factors Influencing Rebleeding after Bronchial Artery Embolization on the Management of Hemoptysis Associated with Pulmonary Tuberculosis

Abstract

BackgroundHemoptysis due to pulmonary tuberculosis (TB) frequently develops in Korea where the prevalence of TB is intermediate. The effect of bronchial artery embolization (BAE) on the control of massive hemoptysis has been well known. This study is designed to identify the risk factors contributing to rebleeding after BAE in patients with TB.MethodsWe retrospectively evaluated risk factors and the time for rebleeding after BAE in 72 patients presenting with hemoptysis.ResultsThe overall immediate success rate of BAE was 93.1% (67 of 72 patients). Of the 29 patients (40.3%) who showed rebleeding after BAE, 13 patients experienced rebleeding within 1 month, and 14 patients between 1 month to 1 year. The existence of a shunt in angiographic finding, aspergilloma, and diabetes mellitus were risk factors of rebleeding after BAE in multivariate analysis.ConclusionBAE was very effective for obtaining immediate bleeding control in hemoptysis associated with active TB or post-TB sequelae. It is important to observe whether or not rebleeding occurs up to 1 year of BAE especially in TB patients with aspergilloma, DM, or a shunt. Even rebleeding can be managed well by second BAE.

Prognosis and Predictors of Rebleeding After Bronchial Artery Embolization in Patients with Active or Inactive Pulmonary Tuberculosis

“…BAE is considered an initial treatment for control of hemoptysis in TB patients with an immediate success rate of about 90 % [2]. Previous studies have reported approximately 10-33 % recurrence in hemoptysis patients [2], with studies performed in Korea among PTB patients reporting rates of 30.6 % [1] and 40.3 % [6]. Although our study included only PTB patients, the frequency of rebleeding was 25 %, which is lower than that reported in previous studies.…”

“…In addition, the recurrence of hemoptysis in patients with chronic PTB is more common than those in patients with bronchiectasis [4]. Previous studies have attempted to find risk factors for recurrent hemoptysis after BAE; there is evidence that recurrent hemoptysis is associated with the presence of a fungal ball [1,[5][6][7], incomplete embolization [8], active PTB [4], diabetes mellitus [6], and systemicpulmonary artery shunts on angiography [6,[9][10][11]. It is important for clinicians to define risk factors of rebleeding after hemoptysis treatment in order to optimize management and follow-up for patients with hemoptysis in clinical practice.…”

Bronchial artery embolization in hemoptysis: a systematic review

“…Recurrence rate was significantly higher in patients with aspergillomas and cavities (5,15,16,21,25,26). In the study by van den Heuvel et al (21), patients with aspergillomas formed 18% of patient population and were associated with an odds ratio of 5.1 for recurrent bleeding as compared to patients without aspergillomas.…”

“…Certain angiographic features such as: a) presence of nonbronchial systemic collaterals, b) bronchopulmonary shunting, and c) incomplete initial embolization were significantly associated with higher recurrence rates (5,12,13,22,23). While a higher recurrence rate has been reported previously in patients with pleural thickening more than 10 mm as it is associated with recruitment of nonbronchial systemic collaterals (30,31), none of the studies in this review observed a significant association between pleural thickening and recurrence.…”

“…We also excluded five studies whose full-texts were not available despite our best efforts. Finally, there were 22 studies (5)(6)(7)(8)(9)(10)(11)(12)(13)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) meeting the selection criteria for this systematic review. The search strategy is schematized in Fig.…”