Study objectives: The management of life-threatening
hemoptysis frequently poses a therapeutic dilemma because such patients
are often poor surgical risks. Less often, patients refuse surgical
intervention. The value of percutaneous embolotherapy, a useful
alternative in these situations, was assessed.
setting, patients, interventions: Sixteen consecutive patients
who underwent percutaneous embolotherapy for life-threatening
hemoptysis in a tertiary-care hospital were evaluated retrospectively.
The bronchial arteries, as well as other intrathoracic arteries, were
evaluated and selectively embolized if they were considered to supply
the pathologic area from which the hemoptysis arose.
Results: The most common cause for hemoptysis was
posttuberculous bronchiectasis (n = 12) with or without mycetomas.
Ten patients required blood transfusions before embolotherapy. Pleural
disease was noted on the chest radiograph in 13 patients and was
generally associated with the presence of nonbronchial systemic
collateral vessels. In three patients, arteries other than the
bronchial arteries were the only source of hemoptysis. Percutaneous
embolotherapy was successful in controlling the hemoptysis in all
patients. The only complication documented was a transient paraparesis
in one patient. Six patients did not return for follow-up. Of the
remaining 10 patients, 3 patients had minor episodes of hemoptysis that
were treated conservatively with success. One patient had significant
recurrent hemoptysis that was managed with radiotherapy. One patient
subsequently underwent a lobectomy.
Percutaneous embolotherapy is a useful therapeutic modality in the
management of life-threatening hemoptysis. The contribution of
nonbronchial systemic collateral vessels, particularly where there is
evidence of coexistent pleural disease, should always be suspected. In
experienced hands, this is a safe and potentially life-saving