BAE is an effective modality in the management of hemoptysis. This study aims to report the Cleveland Clinic experience with bronchial arteriography and BAE, to evaluate the short-terms and long-terms outcomes, and to determine the various possible predictive and prognostic variables.
A review of medical records for all patients who underwent bronchial artery arteriography and embolization between January 1992 and June 2002 at the Cleveland Clinic was carried out to evaluate the demographics, clinical presentation, radiographics studies, bronchoscopy, outcomes, complications and mortality.
43 patients (age 52.7±15; 22M/21F) underwent 57 angiograms of bronchial arteries and collateral vessels and were followed up over 30.2±28.3 months. The most common indication was hemoptysis in 41 (95%). The etiologies were lung malignancies (13), mycetoma (9), pulmonary hypertension (4), fibrosing mediastenitis (3), other identified causes (12), and unidentified causes (2). Bronchoscopy was performed prior to 47 bronchial arteriographies, and the source of bleeding was identified in 44 procedures. Of the 57 angiograms,14 were for recurrent hemoptysis in 8 patients (18.6%). Embolization was successful in 54 sessions in 40 patients (93%). The total number of embolized vessels was 109. The average number of vessels per session was 1.9 (range:0-5). Immediate control of hemoptysis was achieved in 52 procedures corresponding to 39 patients (90.7%). Rebleeding occurred after 16 successful BAE’s in 12 patients (27.9 %) within 30 days, and after 10 in 4 (9.3 %) after 30 days. Twenty one patients (48.8 %) died. Of these, 11 (26%) died in the first 30 days. One patient had pneumothorax and another had perforation of bronchial artery.CONCLUSIONS: BAE is safe and effective in controlling both acute and chronic hemoptysis. In case of recurrence, it can be safely repeated. Mortality rate is dependent mostly on the underlying pathology.
Patients with hemoptysis not controlled with conservative measurements should be considered for BAE awaiting definitive surgical treatment. BAE is appropriate for patients who are not good surgical candidates.
S.A. Ismail, None.