Outcomes and safety of bronchial artery embolization in control of massive hemoptysis

Gehan H Aboel-Magd,Ahmad H Abouissa,Mohamed M Harraz

doi:10.4103/ejb.ejb_51_19

Abstract

BackgroundThe most frequent causes of massive hemoptysis are bronchiectasis, myecetoma, tuberculosis, bronchial carcinoma, and cryptogenic hemoptysis.ObjectiveThis study aimed to investigate the outcomes, safety, and complications of bronchial artery embolization (BAE) in the management of massive hemoptysis.Patients and methodsThis study included 32 patients who presented with massive hemoptysis who were indicated for BAE. The following data were obtained from each patient: detailed history, clinical examination, chest radiograph, computed tomography pulmonary angiography, fiberoptic bronchoscopy, and BAE.ResultsFifteen patients underwent BAE as an urgent procedure for control of massive hemoptysis and 17 patients underwent BAE as an elective procedure. The complications of BAE were fever in four patients (12.5%), back pain in three (9.38%), failure of BAE in two (6.25%), recurrence of hemoptysis in one (3.13%), and no mortality. BAE was successful in 30 out of 32 (93.75%) cases. Failure of catheterization was encountered in one (3.13%) case because of dissection during negotiations; therefore, no catheterization was performed. The second (3.13%) case showed extensive bronchial–pulmonary shunt with severe lung destruction, so that the procedure was deemed futile. After the procedure, immediate control of hemoptysis was achieved in 29 (90.62%) patients.ConclusionBAE can be used safely and effectively for control of massive hemoptysis; it can be used as an alternative nonsurgical option along with medical treatment or as a bridge to stabilize the patient until definitive surgical management can be performed. BAE can be considered an alternative to surgery if the patient is not fit for surgical intervention.

Highlights

Massive hemoptysis is defined as the amount of expectorated blood that endangers the airway patency, causing hemodynamic instability [1,2]
This study aimed to investigate the outcomes, safety, and complications of bronchial artery embolization (BAE) in the management of massive hemoptysis
Patients and methods This study was carried out during the period from December 2014 till February 2019 in the radiology Department in Al-Noor Specialist Hospital, Makkah, Saudi Arabia. It included 32 patients who presented with massive hemoptysis in whom the amount of bleeding was 200–1000 ml over 24 h who were indicated for BAE as a first line of management of massive hemoptysis, failure or contraindications of bronchoscopy or bridge to surgery to stabilize the patient

Summary

Introduction

Massive hemoptysis is defined as the amount of expectorated blood that endangers the airway patency, causing hemodynamic instability [1,2]. There is no definitive volume of expectorated blood for the diagnosis of massive hemoptysis; the amounts of hemoptysis ranging from 200 to 1000 ml over 24 h are considered to be indicative of massive hemoptysis [2]. Massive hemoptysis originates from the bronchial high-pressure circulation in 90% of the cases. In the remaining 5%, pulmonary vessels may be the source of massive hemoptysis [3,4]. The most frequent causes of massive hemoptysis are bronchiectasis, myecetoma, tuberculosis (TB), bronchial carcinoma, and cryptogenic hemoptysis; TB is considered the most common cause, especially in countries with a high prevalence of TB [5]. The most frequent causes of massive hemoptysis are bronchiectasis, myecetoma, tuberculosis, bronchial carcinoma, and cryptogenic hemoptysis

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