Immediate and long-term outcomes of endovascular treatment for massive hemoptysis.

BACKGROUND: The aim of this study was to evaluate the immediate and long-term outcomes of endovascular treatment for massive hemoptysis and to identify the factors influencing outcome.

METHODS: A total of 147 patients who underwent transarterial embolization for massive hemoptysis between 2001 and 2012 were retrospectively evaluated. All patients (93 males and 54 females, ranging in age from 28 to 76 years) had active massive bleeding and underwent bronchial artery embolization (BAE) and/or non-bronchial artery embolization (NBAE). Angiography result, endovascular techniques, embolized materials and complications were recorded.

RESULTS: Complete cessation of massive hemoptysis was achieved in 126/147 patients (85.7%) and failed in 21/147 patients (14.3%) within 24 hours. The etiology of hemoptysis was as follows: bronchiectasis (49.7%), tuberculosis (24.5%), artery malformation (14.3%), lung carcinoma (9.5%) and idiopathic hemoptysis (2.0%). In many patients of tuberculosis and artery malformation, abnormal bronchial and nonbronchial systemic artery-pulmonary circulation shunts were usually found. During a mean follow-up period of 18 months (range from 1 day to 63 months), hemoptysis was controlled in 117(79.6%), ineffective and recurred in 30 (20.4%) and 14 (9.5%) required repeat embolization. A better success rate of 90.4% was obtained in the bronchiectasis group. The worse results were seen in the lung carcinoma group with 42.9%. The tuberculosis and artery malformation groups also demonstrated good results. Transient quadriplegia of major complication was recorded in 1/147 (0.7%). Minor complications such as chest pain, dysphagia and fever were recorded in 45/147 (30.6%).

CONCLUSIONS: BAE and NBAE are safe and effective procedure for treatment for massive hemoptysis, with low recurrence and complication rates. Abnormal bronchial and nonbronchial systemic artery-pulmonary circulation shunts were usually found in many patients of tuberculosis and artery malformation. The better success rate was obtained by the bronchiectasis group, and ineffectiveness and high recurrence rate is associated with lung carcinoma.