Bronchial Artery Embolization: Lifesaving Therapy for Hemoptysis

Abstract

Bronchial arteriography is used mainly to visualize the bronchial arteries and their branches, and it often reveals the bleeding source in patients with hemoptysis. I report my experience with bronchial artery embolization in 280 patients with moderate to severe hemoptysis. The most common cause of bleeding was pulmonary Koch disease or posttubercular bronchiectasis. Gelfoam was used most often as the embolizing material (255 cases); however, embolizing coils were used in 23 cases, and polyvinyl alcohol was used in 2 cases. In almost all cases (91%), the immediate results were very encouraging. There was recurrent bleeding in some cases because of aspergilloma, which is a major problem in the management of hemoptysis. Bleeding recurred in 28 patients who had old tubercular lesions or posttubercular bronchiectasis. Active tubercular patients did well and had less recurrence, perhaps because simultaneous antitubercular treatment contributed to lesion regression. In this series, only 2 patients developed paraparesis, and they recovered over a 4-week period. One patient had massive hemoptysis as soon as the dye was injected in the bronchial artery, and 1 patient showed a rise in blood urea, which returned to normal in 1 week. One patient died of respiratory failure caused by extensive bilateral Koch disease 4 days after the procedure. When performed by knowledgeable and properly trained individuals, bronchial artery embolization provides successful treatment of hemoptysis.