Indicators predictive of success of embolisation: analysis of 88 patients with haemoptysis.

PURPOSE: To identify the risk factors related to relapse of haemoptysis in patients treated with arterial embolisation.

MATERIAL AND METHODS: Eighty-eight patients with haemoptysis (60 M, 28 F; average age 58.9) were examined by bronchial arteriography: 64/88 were subsequently embolised. The clinical and angiographic parameters, immediate and long-term results were analysed. Follow-up ranged from 8 days to 104 months. No major complications were observed.

RESULTS: Patients treated with embolisation (64/88= 72.7%) were divided into two groups. Group 1 (23/64= 35.9%) included patients with relapse of haemoptysis and Group 2 (41/64=64.1%) patients without recurrence during follow-up. In all 64 patients with haemoptysis, embolisation succeeded in stopping the haemorrhage, long-term efficacy was observed in 64.1%; when the treatment was repeated, secondary success was 68.75%. Recurrence after embolisation was correlated to chronic lung disease (p=0.04) especially to pulmonary tuberculosis or mycetoma (p=0.007) and to systemic-pulmonary shunts (p=0.02). The absence of a history of massive haemoptysis was related to a greater likelihood of non-recurrence (p=0.0035). Moreover, complicated tuberculous lesions (Log-rank test p=0.0027), chronic lung disease (p=0.0272) and systemic-pulmonary shunts (p=0.0406) were predictive of an earlier relapse (Kaplan Meier curves and Log-rank test). Comparison of tuberculosis and/or mycetoma with systemic-pulmonary shunting showed the greater impact of infectious lesions on early recurrence.

CONCLUSIONS: Embolisation of abnormal vascularisation, which can be repeated in cases of failure, proved successful in patients with haemoptysis showing definitive or long-term resolution of the clinical picture in about 70% of cases. Patients with tuberculosis or mycetoma with systemic-pulmonary shunting and haemodynamic alterations have a higher risk of early recurrence.