Management of massive hemoptysis by surgical ligation of bronchial and intercostal arteries

Abstract

Massive hemoptysis is a major clinical problem and may present life-threatening situation in patients with chronic pulmonary diseases. Surgical resection has been the procedure of choice in this kind of patients. But, frequently they are not candidate for surgical procedure because of poor pulmonary function, wide-spread lesion and so on. Catheterization and arterial embolization (BAE) have been used successfully to arrest massive and recurrent hemoptysis. But, BAE is a palliative treatment because the primary cause of hypervascularity remains within the lung, and recanalization and revascularization may occur due to collateral circulation and reabsorption of embolized materials. Also another major risk of BAE is spinal cord injury because of existence of anterior spinal arteries seen on preliminary arteriogram.Surgical ligation and resection of bronchial arteries without pulmonary resection have been performed in 4 patients, in whom preliminary arteriogram revealed anastomoses between anterior spinal arteries and bronchial arteries. As for complications caused by bronchial artery ligation, neither spinal cord injury nor any other side effect or recurrence was seen. However, spinal cord injury occurred in one patient as a result of BAE. This complication can occur even in cases in which no significant blood supply to the spinal cord can be seen on preliminary arteriogram.The possibility of controlling massive hemoptysis by ligation of bronchial artery and other feeding arteries may be worth consideration, especially in patients with advanced pulmonary insufficiency who are not incapable to pulmonary resection, in relapsed cases after BAE and in those with arterial feeding anastomoses of the spinal cord seen on preliminary arteriogram.