PURPOSE: The aim of this study is to evaluate usefulness of bronchial artery angiogram (BAA) and bronchial artery embolisation (BAE) in management of hemoptysis at a community-based hospital. BAA and BAE may be life saving procedure in some patients. It can help postpone and/or avoid surgery.
METHODS: Between 1998 and 2005, at New York Hospital Queens 19 patients (12 males, 7 females, age- 20 to 80 years) with significant haemoptysis who underwent BAA were reviewed retrospectively.
RESULTS: Sixteen patients presented with hemoptysis and three developed hemoptysis during hospitalization for other diagnosis. The etiology of hemoptysis was COPD (6), lung cancer (3), bronchiectasis (2), old pulmonary tuberculosis (2), arterio-venous malformation (1), necrotizing pneumonia (1), lung abscess (1), paragonimiasis (1) and mycobacterium avium intracellulare infection (1). Bronchoscopy was done in 13 patients and localized the bleeding site in all. BAA revealed hypertrophied and enlarged bronchial arteries (10), abnormal collateral vessels (3), arterio-venous malformation (3), and normal BAA (5). BAE was done in 13 patients. Primarily polyvinyl alcohol was used for embolisation and coils were used for embolisation of intercostal feeding collaterals. Post- angiogram 15 (78%) patients had resolution of hemoptysis, including 13 with BAE, 1 with repeated BAE for arterio-venous malformation one year later and 1 improved without embolisation. Of the 4 patients with persistent hemoptysis, lobectomy was done in one and radiotherapy was done in one patient.Two patients died due to conditions unrelated to hemoptysis. Complication from BAA was seen in one patient as bronchial artery trauma, which resolved without any sequel or recurrent hemoptysis.
CONCLUSION: BAE is a safe procedure for control of hemoptysis in a community hospital setting. Resolution of hemoptysis was seen in 78% of patients. No serious consequences were noted. Surgical treatment remains the cornerstone therapy for patients who do not respond to BAE.
CLINICAL IMPLICATIONS: BAA and BAE are useful procedures in treatment of uncontrolled hemoptysis in community hospital setting.
DISCLOSURE: Seema Agarwal, No Financial Disclosure Information; No Product/Research Disclosure Information