Dual-vessel intervention treatment for massive hemoptysis caused by lung cavitary lesions: A prospective and comparative study_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LI Geping ^1,2 , ZHANG Rui ³ , YANG Qiuhong ⁴ , WANG Lu ³ , MAO Yu ⁵ ,  HAN Jing ⁶ ,  LUO Wei ^1,2

1. Department of Respiratory and Critical Care Medicine, the affiliated hospital of southwest medical university, Luzhou, Sichuan 646000, PR China;
2. Department of Respiratory and Critical Care Medicine, The People’s Hospital of Leshan, Leshan 614000, Sichuan, PR China;
3. Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, Chongqing 400042, PR China;
4. Department of Respiratory and Critical Care Medicine, The 7th Hospital of Chengdu, Chengdu, Sichuan 610041, PR China;
5. Department of Pathology, The People’s Hospital of Leshan, Leshan, Sichuan 614000, PR China;
6. Department of Pulmonary and Critical Care Medicine, The People’s Hospital of Leshan Wutongqiao District, Wutongqiao, Sichuan 618000, PR China;

Corresponding?author：

HAN Jing, Email: 43978159@qq.com; LUO Wei, Email: 451188923@qq.com

Keywords：

Massive hemoptysi; lung cavitary lesion; bronchial artery angiography/embolization; pulmonary arterial embolization; culprit vessel; bronchopulmonary fistula

DOI：

10.7507/1671-6205.202603026

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To compare the outcomes of dual-vessel intervention (DVI), including bronchial arterial embolization (BAE) and pulmonary arterial angiography/embolization (PAA/E), with those of BAE alone in managing massive hemoptysis caused by cavitary lung lesions.Method This multicenter, prospective trial enrolled patients with massive hemoptysis, who were assigned to either the DVI or BAE group. The endpoint included the hemoptysis recurrence rate, technical and clinical success rates. Risk factors for hemoptysis recurrence and the anatomic basis were analyzed.Results A total of 75 patients (37 in the DVI group,38 in the BAE group) with a mean age of 59.8 ± 10.4 years were enrolled. On average, 3.32±3.81 vessels were identified as culprit vessels in each patient, with a mean diameter of 3.18±1.24 mm. The most common ectopic vessel was the intercostal artery, followed by subclavian artery branches. Overall, the fistula rate was 80%, and the most common fistula was between the bronchial and pulmonary arteries. The technical and clinical success rates were greater in the DVI group without statistical significance. However, the recurrence rate was marginally significantly lower in the DVI group (8.6%) than in the BAE group (26.5%) (P=0.056). Aspergilloma was associated with a significantly greater risk of hemoptysis recurrence (P=0.006). Increased microvessels, occlusive pulmonary vessels, unbalanced hypertrophic bronchial and pulmonary arteries and Singular-millimetric-fibrovascular (SiMFis) -like lesion were detected in lung cavitary specimens.Conclusions DVI is more effective than BAE in the management of massive hemoptysis caused by cavitary lesions. Many culprit vessels with enlarged diameters and a high ratio of vascular fistula of cavitary lesions were detected. The high proportion of fistulas on pulmonary angiography could be partly attributed to the presence of SiMFis-like lesion.

Citation： LI Geping, ZHANG Rui, YANG Qiuhong, WANG Lu, MAO Yu, HAN Jing, LUO Wei. Dual-vessel intervention treatment for massive hemoptysis caused by lung cavitary lesions: A prospective and comparative study. Chinese Journal of Respiratory and Critical Care Medicine, 2026, 25(6): 391-399. doi: 10.7507/1671-6205.202603026 Copy

1.
2.	Lorenz J, Sheth D, Patel J. Bronchial artery embolization. Semin Intervent Radiol. 2012, 29(3): 155-160.
3.	Karlafti E, Tsavdaris D, Kotzakioulafi E, et al. Which Is the Best Way to Treat Massive Hemoptysis? A Systematic Review and Meta-Analysis of Observational Studies. J Pers Med. 2023, 13(12): 1649.
4.	Hwang JH, Kim JH, Park S, et al. Feasibility and outcomes of bronchial artery embolization in patients with non-massive hemoptysis. Respir Res. 2021, 22(1): 221.
5.
6.	Panda A, Bhalla AS, Goyal A. Bronchial artery embolization in hemoptysis: a systematic review. Diagn Interv Radiol. 2017, 23(4): 307-317.
7.	He G, Liu W, Gao Z, et al. Intervention treatment on massive hemoptysis of pulmonary aspergilloma. Exp Ther Med. 2017, 13(5): 2259-2262.
8.	Ding WY, Chan T, Yadavilli RK, McWilliams R. Aspergilloma and massive haemoptysis. BMJ Case Rep. 2014, 2014: bcr2013200019.
9.	Yang Q, Cheng Luo L, Wei H, et al. Dual-vessel intervention treatment for massive hemoptysis caused by lung cavitary lesions. Eur J Radiol. 2022, 154: 110448.
10.	Sopko DR, Smith TP. Bronchial artery embolization for hemoptysis. Semin Intervent Radiol. 2011, 28(1): 48-62.
11.	Humbert M, Guignabert C, Bonnet S, et al. Pathology and pathobiology of pulmonary hypertension: state of the art and research perspectives. Eur Respir J. 2019, 53(1): 1801887.
12.	Kettenbach J, Ittrich H, Gaubert JY, et al. CIRSE Standards of Practice on Bronchial Artery Embolisation. Cardiovasc Intervent Radiol. 2022, 45(6): 721-732.
13.	Le HY, Le VN, Pham NH, et al. Value of multidetector computed tomography angiography before bronchial artery embolization in hemoptysis management and early recurrence prediction: a prospective study. BMC Pulm Med. 2020, 20(1): 231.
14.	Luo W, Wei MG, Wei HL, et al. Cerebral infarction after drug-eluting bead bronchial arterial chemoembolization due to the mechanical force-mediated opening of an errant passage. Chin Med J (Engl). 2020, 134(8): 989-990.
15.	Hoffman M, Gerding JP, Zuckerman JB. Stroke and myocardial infarction following bronchial artery embolization in a cystic fibrosis patient. J Cyst Fibros. 2017, 16(1): 161-162.
16.	Denning DW, Cadranel J, Beigelman-Aubry C, et al. Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management. Eur Respir J. 2016, 47(1): 45-68.
17.	Nunes AG, Rodrigues MC, Carneiro C, et al. Pulmonary cavitary lesions: a captivating visual review. J Thorac Dis. 2025, 17(8): 6296-6308.
18.	Ghigna, M. -R. , Dorfmüller, P. (2019). Pulmonary vascular disease and pulmonary hypertension. Diagnostic Histopathology 25(8), 304–312.
19.	Galambos C, Sims-Lucas S, Abman SH, et al. Intrapulmonary Bronchopulmonary Anastomoses and Plexiform Lesions in Idiopathic Pulmonary Arterial Hypertension. Am J Respir Crit Care Med. 2016, 193(5): 574-576.
20.	Ghigna MR, Guignabert C, Montani D, et al. BMPR2 mutation status influences bronchial vascular changes in pulmonary arterial hypertension. Eur Respir J. 2016, 48(6): 1668-1681.
21.	Strieter RM, Gomperts BN, Keane MP. The role of CXC chemokines in pulmonary fibrosis. J Clin Invest. 2007, 117(3): 549-556.

1.
2. Lorenz J, Sheth D, Patel J. Bronchial artery embolization. Semin Intervent Radiol. 2012, 29(3): 155-160.
3. Karlafti E, Tsavdaris D, Kotzakioulafi E, et al. Which Is the Best Way to Treat Massive Hemoptysis? A Systematic Review and Meta-Analysis of Observational Studies. J Pers Med. 2023, 13(12): 1649.
4. Hwang JH, Kim JH, Park S, et al. Feasibility and outcomes of bronchial artery embolization in patients with non-massive hemoptysis. Respir Res. 2021, 22(1): 221.
5.
6. Panda A, Bhalla AS, Goyal A. Bronchial artery embolization in hemoptysis: a systematic review. Diagn Interv Radiol. 2017, 23(4): 307-317.
7. He G, Liu W, Gao Z, et al. Intervention treatment on massive hemoptysis of pulmonary aspergilloma. Exp Ther Med. 2017, 13(5): 2259-2262.
8. Ding WY, Chan T, Yadavilli RK, McWilliams R. Aspergilloma and massive haemoptysis. BMJ Case Rep. 2014, 2014: bcr2013200019.
9. Yang Q, Cheng Luo L, Wei H, et al. Dual-vessel intervention treatment for massive hemoptysis caused by lung cavitary lesions. Eur J Radiol. 2022, 154: 110448.
10. Sopko DR, Smith TP. Bronchial artery embolization for hemoptysis. Semin Intervent Radiol. 2011, 28(1): 48-62.
11. Humbert M, Guignabert C, Bonnet S, et al. Pathology and pathobiology of pulmonary hypertension: state of the art and research perspectives. Eur Respir J. 2019, 53(1): 1801887.
12. Kettenbach J, Ittrich H, Gaubert JY, et al. CIRSE Standards of Practice on Bronchial Artery Embolisation. Cardiovasc Intervent Radiol. 2022, 45(6): 721-732.
13. Le HY, Le VN, Pham NH, et al. Value of multidetector computed tomography angiography before bronchial artery embolization in hemoptysis management and early recurrence prediction: a prospective study. BMC Pulm Med. 2020, 20(1): 231.
14. Luo W, Wei MG, Wei HL, et al. Cerebral infarction after drug-eluting bead bronchial arterial chemoembolization due to the mechanical force-mediated opening of an errant passage. Chin Med J (Engl). 2020, 134(8): 989-990.
15. Hoffman M, Gerding JP, Zuckerman JB. Stroke and myocardial infarction following bronchial artery embolization in a cystic fibrosis patient. J Cyst Fibros. 2017, 16(1): 161-162.
16. Denning DW, Cadranel J, Beigelman-Aubry C, et al. Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management. Eur Respir J. 2016, 47(1): 45-68.
17. Nunes AG, Rodrigues MC, Carneiro C, et al. Pulmonary cavitary lesions: a captivating visual review. J Thorac Dis. 2025, 17(8): 6296-6308.
18. Ghigna, M. -R. , Dorfmüller, P. (2019). Pulmonary vascular disease and pulmonary hypertension. Diagnostic Histopathology 25(8), 304–312.
19. Galambos C, Sims-Lucas S, Abman SH, et al. Intrapulmonary Bronchopulmonary Anastomoses and Plexiform Lesions in Idiopathic Pulmonary Arterial Hypertension. Am J Respir Crit Care Med. 2016, 193(5): 574-576.
20. Ghigna MR, Guignabert C, Montani D, et al. BMPR2 mutation status influences bronchial vascular changes in pulmonary arterial hypertension. Eur Respir J. 2016, 48(6): 1668-1681.
21. Strieter RM, Gomperts BN, Keane MP. The role of CXC chemokines in pulmonary fibrosis. J Clin Invest. 2007, 117(3): 549-556.

Chinese Journal of Respiratory and Critical Care Medicine

Dual-vessel intervention treatment for massive hemoptysis caused by lung cavitary lesions: A prospective and comparative study

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