[Expert consensus on operational procedures for bronchial artery embolization in the treatment of hemoptysis]

Abstract

Hemoptysis is a severe clinical symptom of the respiratory system, which can lead to asphyxiation and endanger life in severe cases. Treatment options include medical therapy, bronchoscopy, vascular interventions, and surgical procedures. Among these, bronchial artery embolization (BAE) has emerged as a pivotal interventional technique for managing hemoptysis due to its minimally invasive nature and robust hemostatic efficacy. BAE is now widely utilized in clinical settings, particularly in the urgent management of massive hemoptysis. However, the complexity of the procedure and the absence of standardized protocols and technical guidelines in China have limited its widespread adoption. To enhance the quality and consistency of BAE, particularly in the diagnosis and management of massive hemoptysis, the Pulmonary Embolism and Pulmonary Vascular Diseases Group of the Chinese Thoracic Society, the Pulmonary Embolism and Pulmonary Vascular Disease Working Group of the Chinese Medical Doctor Association, and the National Working Group for the Prevention and Treatment of Pulmonary Embolism and Pulmonary Vascular Diseases have collaboratively developed the "Expert Consensus on Procedural Standards for Bronchial Artery Embolization in the Treatment of Hemoptysis." This consensus provides a comprehensive overview of bronchial artery anatomy, indications and contraindications for BAE, procedural guidelines, complication prevention and management, as well as postoperative care, with the objective of further standardizing the clinical application of BAE.Recommendations1.Given the complexity of bronchial artery anatomy, various projection angles should be utilized intraoperatively to fully visualize the morphology of the affected vessels.2.The primary culprit vessels in hemoptysis are typically the bronchial arteries, ectopic bronchial arteries, and non-bronchial systemic arteries. However, vigilance is still required for hemoptysis originating from pulmonary arteries and veins.3.It is recommended to establish a multidisciplinary team for hemoptysis management to collaboratively develop tailored treatment plans.4.In cases where the patient exhibits signs of asphyxiation, a prompt assessment of the need for tracheal intubation is crucial to maintain airway patency. If necessary, perioperative management should include endoscopic intervention.5. Preoperative bronchial artery CT angiography is recommended to thoroughly identify and assess the responsible vessels before BAE.6. Prior to embolization, comprehensive angiography of all implicated vessels should be performed. The use of coaxial microcatheter techniques and appropriate embolization materials is recommended for super-selective embolization to avoid non-target embolization.7. Long-term management and follow-up of patients post-BAE is advised, including health education and a focus on treating the underlying condition to reduce the risk of hemoptysis recurrence.