Embolización bronquial en el tratamiento de la hemoptisis

Abstract

The aim of this retrospective study was to evaluate the efficacy of bronchial artery embolization to treat hemoptysis. Eight hundred sixty-five patients were admitted to our hospital with hemoptysis during the study period. Bronchial arteriographs were obtained for 48, who suffered life-threatening hemoptysis refractory to medical treatment. The likely origin of bleeding was identified in 37: embolization was performed with particles measuring 250 to 1000 micra in size (Contour Emboli, Interventional Therapeutic Corporation, South San Francisco, California, USA) in 35 and with hemostatic collagen sponges in 2. The most common causes of hemoptysis were bronchiectasis (40%), pulmonary tuberculosis (33%), pulmonary aspergilloma (8%) and malignant neoplasm (8%), chronic bronchitis (6%); 4% of the cases were idiopathic. Immediate technical success was achieved in 34 patients (92%) as defined by the absence of hemorrhage for at least 24 hours. All embolized patients were followed until the first recurrence of bleeding or until discharge. Recurrence of hemoptysis (in the first month) was early in 5 patients (13.5%) and late (2 to 96 months) in 9 (24%). The severity of the initial and later episodes of hemoptysis was similar in all early recurrences and most late recurrences. A second embolization was performed six times, and medical and/or surgical treatment was given in all other cases. No significant complications attributable to the technique were observed. The results show that bronchial embolization is valid for the immediate control of life-threatening hemoptysis and has a low rate of severe complication; recurrence is relatively common.