Effect of Bronchial Artery Embolization(BAE) in Management of Massive Hemoptysis

Yeo, Dong Seung; Lee, Suk Young; Hyun, Dae Seong; Lee, Sang Hak; Kim, Seok Chan; Choi, Young Mee; Suhr, Ji Won; Ahn, Joong Hyun; Song, So Hyang; Kim, Chi Hong; Moon, Hwa Sik; Song, Jeong Sup; Park, Sung Hak; Kim, Ki Tae

Abstract

BACKGROUND: Massive and untreated hemoptysis is associated with a mortality of greater than 50 percent. Since the bleeding is from a bronchial arterial source in the vast majority of patients, embolization of the bronchial arteries(BAE) has become an accepted treatment in the management of massive hemoptysis because it achieves immediate control of bleeding in 75 to 90 percent of the patients.
METHODS
Between 1990 and 1996, we treated 146 patients with hemoptysis by bronchial artery embolization. Catheters(4, 5, or 7F) and gelfoam, ivalon, and / or microcoil were used for embolization.
RESULTS
Pulmonary tuberculosis and related disorders were the most common underlying disease of hemoptysis(72.6%). Immediate success rate to control bleeding within 24hours was 95%, and recurrence rate was 24.7%. The recurrence rate occured within 6 months after embolization was 63.9%. Initial angiographic findings such as bilaterality, systemic-pulmonary artery shunt, neovascularity, aneurysm were not statistically correlated with rebleeding tendency(P>0.05). Among Initial radiographic findings,only pleural lesions were significantly correlated with rebleeding tendency(P<0.05). At additional bronchial artery angiograpy done due to rebleeding, recanalization of previous embolized arteries were 63.9%, and the presence of new feeding arteries were 16.7%, and 19.4% of patients with rebleeding showed both. The complications such as fever, chest pain, headache, nausea and vomiting, arrhythmia, paralylytic ileus, transient sensory loss(lower extremities), hypotension, urination difficulty were noticed at 40 patients(27.4%).
CONCLUSION
We conclude that bronchial artery embolization is relatively safe method achieving immediate control of massive hemoptysis. At initial angiographic findings, we could not find any predictive factors for subsequent rebleeding. It may warrant further study whether patients with pleural disease have definetely increased rebleeding tendency.