Bronchial Artery Embolisation for Massive Haemoptysis: Immediate and Long-Term Outcomes-A Retrospective Study

Abstract

Introduction: Bronchial artery embolisation (BAE) is an established treatment method for massive haemoptysis. The aim of this study is to evaluate the impact of BAE on in-hospital outcomes and long-term survival in patients with massive haemoptysis.

Methods: Retrospective review of all cases of acute massive haemoptysis treated by BAE between April 2000 and April 2012 with at least a 5 year follow up of each patient. Targeted BAE was performed in cases with lateralising symptoms, bronchoscopic sites of bleeding or angiographic unilateral abnormal vasculature. In the absence of lateralising symptoms or signs, bilateral BAE was performed.

Results: 96 BAEs were performed in 68 patients. The majority (64 cases, 67%) underwent unilateral procedures. 83 (86.5%) procedures resulted in immediate/short term control of haemoptysis which lasted for longer than a month. The mean duration of haemoptysis free period after embolisation was 96 months. There were three major complications (cardio-pulmonary arrest, paraparesis and stroke). 38 (56%) patients were still alive at least 5 years following their BAE. Benign causes were associated with significantly longer haemoptysis free periods, mean survival 108 months compared to 32 months in patients with an underlying malignant cause (p = 0.005). An episode of haemoptysis within a month of the initial embolisation was associated reduced overall survival (p = 0.033).

Conclusion: BAE is effective in controlling massive haemoptysis. Long-term survival depends on the underlying pulmonary pathology. Strategies are required to avoid incomplete initial embolisation, which is associated with ongoing haemoptysis and high mortality despite further BAE.

Keywords: Bronchial arteries; Haemoptysis; Therapeutic embolisation.

Fig. 1

Angiographic runs demonstrating a hypertrophied right bronchial artery (black arrow) (a), a torturous hypertrophied left intercostal artery (black arrowhead) (b), right broncho-intercostal trunk with abnormal vascularity (white arrow) (c) and a hypertrophied left 4th/5th common intercostal trunk with associated pulmonary blush (asterisk) and pulmonary venous shunting (white arrowhead) (d)

Fig. 2

Flush aortogram showing normal bronchial arteries (arrow) and intercostal arteries (a). Angiographic runs following selective catherisation on the same patient demonstrating normal common origin with normal right and left bronchial arteries (b) and normal right and left subclavian and internal mammary arteries (c and d)

Fig. 3

Event free survival curve of 57 patients with massive haemoptysis treated with bronchial artery embolisation

Fig. 4

Multivariate Cox regression analysis, benign causes were significantly associated with longer haemoptysis free periods (p = 0.005)