Objective To evaluate the clinical effects of bronchial artery embolization ( BAE) for massive hemoptysis due to bronchiectasis.Methods 205 patients with massive hemoptysis were treated with bronchial artery embolization using coils, polyvinyl alcohol ( PVA) microspheres, line segmen, and gelatin sponge after the site of bleeding or the abnormal arteries were identified by arteriography. Super selective bronchial artery embolization was performed with a coaxial microcatheter inserted into the bronchial artery. Results BAE was successfully performed in 205 cases with massive hemoptysis ( left and right bronchial artery embolization in 35 cases, left bronchial artery embolization in 20 cases, right bronchial artery embolization in 126 cases, common bronchial artery embolization in 22 cases, right inferior phrenic artery embolization in 2 cases) . Of 205 patients, 169 were cured, 24 were relieved with a success rate of 94.1% . Long termcumulative hemoptysis nonrecurrence rates was 82.4% . 23 patients developed post embolization syndrome characterized by mild fever and chest pain and ended with spontaneous recovery without special management. No severe complications including spinal cord injury or dystopia embolization were observed. Conclusions Bronchial arterial embolization interventional therapy is a rapid, safe and effective method in the treatment of massive hemoptysis due to bronchiectasis.
ObjectiveTo 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.MethodThis 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.ResultsA 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.ConclusionsDVI 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.