Abstract No. 47 Recurrent bleeding and post-procedural complications following bronchial artery embolization for hemoptysis: a meta-analysis of 2661 patients

Abstract

Bronchial artery embolization (BAE) is one of the established treatments for the management of hemoptysis. Technical advances have increased the safety and efficacy of BAE in the past decades. Nevertheless, BAE is known to be associated with major complications like spinal infarction, commonly presenting as paraplegia. Life-threatening recurrent bleeding and death can result from hemoptysis even after successful BAE. The purpose of our study was to systematically review the available evidence and pool patient-level data to quantify the risk of major complications, spinal infarction, and recurrent bleeding in patients receiving emergent BAE for hemoptysis. We performed a systematic review of literature for clinical studies (case series, cross-sectional studies, and non-randomized clinical trials) evaluating the safety and efficacy of BAE for immediate control of hemoptysis. Quality assessment and risk of bias determination was performed using the risk of bias in non-randomized studies of interventions (ROBINS-1) tool. Event rates were extracted and pooled using random-effect models. The effect of age and gender on major complications following BAE was evaluated by meta-regression analysis. Overall, 697 records were identified and screened at the level of abstracts. 128 studies were further evaluated at the level of full texts and 17 final studies, comprising 2661 patients, fulfilled our inclusion and exclusion criteria and were included in the meta-analysis. An estimated 2.8% (1.6 - 4.9; Z-value: 12.16, P< 0.01) of patients had major complications following BAE (post-procedural complications including spinal infarction and cerebrovascular accident, and death despite BAE attempt). Rate of spinal infarction following BAE was estimated at 1.0% (0.6 - 1.7; Z-value :16.20, P< 0.01). We found significant heterogeneity in the risk of recurrent bleeding following BAE in studies with different lengths of follow-ups, resulting in an overall 25.7% (18.0 - 35.3; Z-value: 4.57, P< 0.01) recurrent bleeding. Patients’ age was inversely associated with major complications (beta: -0.03 ± 0.01 per year of age, P< 0.01). No significant association between gender and major complications was identified (beta: -0.41 ± 0.80; P:0.60 [sic]).. BAE is a relatively safe procedure with a 2.8% risk of major complications including a 1.0% risk of spinal infarction, leaving 1.8% for other complications. Despite technically successful BAE, about 25.7% of patients are estimated to have recurrent bleeds that may be life-threatening.