Abstract
Aim: Purpose of the study was to investigate the efficacy of empiric arterial embolization in order to achieve hemostasis in patients with massive hemoptysis. Materials and Methods: A retrospective review of histories and interventional studies of 56 patients (40 male, 16 female, median age 57 years; range, 16 - 83 years) referred for endovascular treatment of massive hemoptysis over a period of 17 years. Arteries supposed to supply the bleeding bronchoalveolar sections were embolized with particles in all cases. Digital subtraction angiographical (DSA) studies were analyzed with respect to the morphology of the embolized arteries. Arteries were termed pathologic when they were either hypertrophic or supplied hypervascular lung sections as well as actively bleeding branches. Empiric embolization was defined as endovascular occlusion of arteries without visible contrast-material extravasation on DSA studies. Results: Continuing hemoptysis was encountered in one (25%) of 4 patients with active contrast extravasation and in 11 (21%) of 52 empirically embolized patients: Six (19%) of 32 patients with pathologic arteries visible on aortography, 3 (18%) of 17 with pathologic arteries visible by selective arteriography and 2 (67%) of 3 with no visible pathologic arteries. From 6 patients (11%, 5 male, 1 female) who died within 30 days after embolization, 3 suffered from tuberculosis while 3 had malignant tumors. Three had ongoing hemoptysis. One patient died of multiple organ failure caused by post-interventional paraplegia and consecutive pneumonia. Conclusion: In patients with hemoptysis, empirical embolization is effective when pathologic bronchial arteries can be identified by DSA.
Highlights
The resurgence of tuberculosis in industrialized western nations since the 1980s [1] has been the major factor to keep hemoptysis in daily clinical routine [2]
Considered as gold standard, bronchial artery embolization (BAE) is the therapy of choice to control severe hemoptysis in the majority of cases [7,9,12,151-18] We detected active extravasation in 7%, compared with 10.7 % reported in other studies [19]
Continuous hemoptysis was reported in 20% of the patients who underwent empirical embolization and in 25% of the patients with active contrast extravasation
Summary
The resurgence of tuberculosis in industrialized western nations since the 1980s [1] has been the major factor to keep hemoptysis in daily clinical routine [2] Aside this most common cause, the occurrence of hemoptysis in patients worldwide most often occurs in the setting of chronic inflammatory processes including other infectious diseases (such as aspergillosis) and noninfectious etiologies including neoplasms, cystic fibrosis and bronchiectasis [3]. Massive hemoptysis is usually defined as an oral volume loss of more than 300 ml in a 24 hour period [5,6]. It is a serious potentially life threatening condition, as bleeding into the tracheobronchial tree will inevitably occur, resulting in asphyxiation. Considering the dreary consequences, swift actions must be taken against hemorrhage resulting in compromise of the patient’s pulmonary or hemodynamic status [7]
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