Comparison of effects of different bronchial artery embolization methods in re-treatment and initial treatment of tuberculosis hemoptysis

Abstract

Objective To evaluate the clinical effects of different bronchial artery embolization (BAE) methods in the re-treatment and initial treatment of tuberculosis hemoptysis. Methods A total of 49 patients with tuberculosis hemoptysis re-treated and initially treated with triple and double BAE in our hospital were retrospectively analyzed. There were 29 cases of re-treated tuberculosis: 15 cases were treated with triple embolization and 14 cases with double embolization; and there were 20 cases of initially treated tuberculosis: 11 cases were treated with triple embolization and 9 cases with double embolization. The triple embolization was as follows: at the first stage, 350-560 µm PVA particles were used to embolize the distal small vessels; at the second stage, 710-1 000 µm PVA particles were used to embolize the middle small and medium vessels; at the third stage, 2 mm×4 mm tower-shaped ciliated spring ring was used to embolize the proximal main vessels. The double embolization was as follows: PVA particles of corresponding specifications were used to embolize the distal small vessels and middle small and medium vessels, respectively. The patients were followed up for 1 to 3 years, and the effective rate, causes of recurrence, and countermeasures were analyzed. Results There were 48 cases of immediate hemostasis after the first embolization in 49 patients, accounting for 98.0%, 1 case of immediate hemostasis after the second embolization. There were 38 total effective (cured + effective) cases, accounting for 77.6%; the disease recurred in 11 patients during 30 d~3 years after the operation, with the recurrence rate of 22.4%. Among 29 cases of re-treated tuberculosis: 15 cases were treated with triple BAE, there were 13 effective cases and 2 cases of recurrence, with the effective rate of 86.7% (13/15); the other 14 cases were treated with double BAE: there were 8 effective cases and 6 cases of recurrence, with the effective rate of 57.1% (8/14). Among 20 cases of initially treated tuberculosis: 11 cases were treated with triple BAE: there were 10 effective cases and 1 case of recurrence, with the effective rate of 90.9% (10/11); the other 9 cases were treated with double BAE: there were 7 effective cases and 2 cases of recurrence, with the effective rate of 77.8% (7/9). The results showed that the difference in the effects in the re-treatment of tuberculosis hemoptysis with triple embolization and double embolization was statistically significant (P 0.05). The main causes of recurrence were embolization leakage and the formation of collateral circulation. Conclusion BAE has good and quick effects in treating tuberculosis hemoptysis. The selection of the optimum embolization according to the type of hemoptysis can effectively prevent embolization leakage and the regeneration of collateral circulation and helps to reduce the recurrence rate of tuberculosis hemoptysis. Key words: Pulmonary tuberculosis; Hemoptysis; Bronchial artery embolization (BAE)