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Semin intervent Radiol 2006; 23(3): 223-229
DOI: 10.1055/s-2006-948759
Copyright © 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Bronchial Artery Embolization for Treatment of Life-Threatening Hemoptysis

January K. Lopez1 , Hsin-Yi Lee2
  • 1Department of Radiology, University of California at Los Angeles
  • 2Department of Radiology, VA Greater Los Angeles Healthcare System, West Los Angeles, California
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Publication History

Publication Date:
16 August 2006 (online)

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ABSTRACT

Massive hemoptysis is an emergent and life-threatening condition with a broad range of underlying causes. Fortunately, massive hemoptysis accounts for a minority of cases of hemoptysis, ~5%. Unlike hemorrhage in other areas of the body, the primary cause of death from pulmonary hemorrhage is most commonly asphyxiation rather than exsanguination. Given the limited capacity for the lung to preserve oxygen transfer in the setting of massive hemoptysis, a rapid and effective method for controlling hemorrhage is essential to minimize death in patients demonstrating respiratory compromise. Since its introduction in 1973, bronchial artery embolization has proven to be a safe and effective tool for the treatment of massive hemoptysis and is now considered the treatment of choice, with initial success rates ranging from 77 to 94%. The long-term control rate of hemoptysis ranges from 70 to 85% and is largely a function of the degree of inflammation and the natural progression of the underlying disease. This article reviews the current literature on bronchial artery embolization for the treatment of massive hemoptysis.

KEYWORDS

Hemoptysis - massive hemoptysis - bronchial artery embolization - embolization

REFERENCES

  • 1 The clinical history and physical examination. In: Fraser RS, Muller NL, Colman N, Pare PD Diagnosis of Diseases of the Chest. Philadelphia; WB Saunders 1999: 379-403
    Google Scholar
  • 2 de Gregorio M A, Medrano J, Mainar A et al.. Endovascular treatment of massive hemoptysis by bronchial artery embolization: short-term and long-term follow-up over a 15-year period.  Arch Bronconeumol. 2006;  42 49-56
    CrossrefPubMedGoogle Scholar
  • 3 Corr P D. Bronchial artery embolization for life-threatening hemoptysis using tris-acryl microspheres: short-term result.  Cardiovasc Intervent Radiol. 2005;  28 439-441
    CrossrefPubMedGoogle Scholar
  • 4 Ustunsoz B, Bozlar U, Ors F, Gurkok S, Balkan A, Ilica T. Bronchial artery embolization: experience with 10 cases.  Diagn Interv Radiol. 2006;  12 43-46
    PubMedGoogle Scholar
  • 5 Yoon W, Kim J K, Kim Y H, Chung T W, Kang H K. Bronchial and nonbronchial systemic artery embolization for life-threatening hemoptysis: a comprehensive review.  Radiographics. 2002;  22 1395-1409
    CrossrefPubMedGoogle Scholar
  • 6 Crocco J A, Rooney J J, Fankushen D S et al.. Massive hemoptysis.  Arch Intern Med. 1968;  121 495-498
    CrossrefPubMedGoogle Scholar
  • 7 Gourin A, Garzon A A. Operative treatment of massive hemoptysis.  Ann Thorac Surg. 1974;  18 52-60
    CrossrefPubMedGoogle Scholar
  • 8 Sehhat S, Oreizie M, Moinedine K. Massive pulmonary hemorrhage: surgical approach as choice of treatment.  Ann Thorac Surg. 1978;  25 12-15
    PubMedGoogle Scholar
  • 9 Swanson K L, Johnson C M, Prakash U B, McKusick M A, Andrews J C, Stanson A W. Bronchial artery embolization: experience with 54 patients.  Chest. 2002;  121 789-795
    CrossrefPubMedGoogle Scholar
  • 10 Fernando H C, Stein M, Benfield J R, Link D P. Role of bronchial artery embolization in the management of hemoptysis.  Arch Surg. 1998;  133 862-886
    CrossrefPubMedGoogle Scholar
  • 11 Marshall T J, Jackson J E. Vascular intervention in the thorax: bronchial artery embolization for hemoptysis.  Eur Radiol. 1997;  7 1221-1227
    CrossrefPubMedGoogle Scholar
  • 12 Cauldwell E W, Siekert R G, Lininger R E, Anson B J. The bronchial arteries: an anatomic study of 150 human cadavers.  Surg Gynecol Obstet. 1948;  86 395-412
    PubMedGoogle Scholar
  • 13 Chun H J, Byun J Y, Yoo S S, Choi B G. Added benefit of thoracic aortography after transarterial embolization in patients with hemoptysis.  AJR Am J Roentgenol. 2003;  180 1577-1581
    CrossrefPubMedGoogle Scholar
  • 14 Tanomkiat W, Tanisaro K. Radiographic relationship of the origin of the bronchial arteries to the left main bronchus.  J Thorac Imaging. 2003;  18 27-33
    CrossrefPubMedGoogle Scholar
  • 15 Mauro M A, Jaques P F. Transcatheter bronchial artery embolization for inflammation (hemoptysis). In: Baum S, Pentecost M Abrams' Angiography. Boston; Lippincott Williams and Wilkins 1997: 819-828
    Google Scholar
  • 16 Kardjiev V, Symeonov A, Chankov I. Etiology, pathogenesis, and prevention of spinal cord lesions in selective angiography of the bronchial and intercostals arteries.  Radiology. 1974;  112 81-83
    CrossrefPubMedGoogle Scholar
  • 17 Feigelson H H, Ravin H A. Transverse myelitis following selective bronchial arteriography.  Radiology. 1965;  85 663-665
    CrossrefPubMedGoogle Scholar
  • 18 Lois J F, Gomes A S, Smith D C, Laks H. Systemic-to-pulmonary collateral vessels and shunts: treatment with embolization.  Radiology. 1988;  169 671-676
    PubMedGoogle Scholar
  • 19 Doppman J L, Girton M, Oldfield E H. Spinal WADA test.  Radiology. 1986;  161 319-321
    CrossrefPubMedGoogle Scholar
  • 20 Schrodt J F, Becker G J, Scott J A, Warren C H, Benenati S V. Bronchial artery embolization-monitoring with somatosensory evoked potentials: work in progress.  Radiology. 1987;  164 135-139
    CrossrefPubMedGoogle Scholar
  • 21 White Jr R I. Bronchial artery embolotherapy for control of acute hemoptysis: analysis of outcome.  Chest. 1999;  115 912-915
    CrossrefPubMedGoogle Scholar
  • 22 Pump K. Distribution of bronchial arteries in human lung.  Chest. 1972;  62 447-451
    CrossrefPubMedGoogle Scholar
  • 23 Boushy S F, Helgason A H, North L B. Occlusion of the bronchial arteries by glass microspheres.  Am Rev Respir Dis. 1971;  103 249-263
    PubMedGoogle Scholar
  • 24 Fuhrman B P, Bass J L, Castaneda-Zuniga W, Fuhrman B P, Rashkind W J, Lucas Jr R V. Coil embolization of congenital thoracic vascular anomalies in infants and children.  Circulation. 1984;  70 285-289
    PubMedGoogle Scholar
  • 25 Ishikawa H, Kimura T, Oya A et al.. Application of interlocking detachable coil (IDC) in superselective bronchial artery embolization.  Nihon Kokyuki Gakkai Zasshi. 2004;  42 730-736
    PubMedGoogle Scholar
  • 26 Remy J, Arnaud A, Fardou H et al.. Treatment of hemoptysis by embolization of bronchial arteries.  Radiology. 1977;  122 33-37
    CrossrefPubMedGoogle Scholar
  • 27 Uflacker R, Kaemmerer A, Picon P D et al.. Bronchial artery embolization in the management of hemoptysis: technical aspects and long-term results.  Radiology. 1985;  157 637-644
    CrossrefPubMedGoogle Scholar
  • 28 Rabkin J E, Astafjev V I, Gothman L N, Grigorjev Y G. Transcatheter embolization in the management of pulmonary hemorrhage.  Radiology. 1987;  163 361-365
    CrossrefPubMedGoogle Scholar
  • 29 Hayakawa K, Tanaka F, Torizuka T et al.. Bronchial artery embolization for hemoptysis: immediate and long-term results.  Cardiovasc Intervent Radiol. 1992;  15 154-158
    CrossrefPubMedGoogle Scholar
  • 30 Tamura S, Kodama T, Otsuka N et al.. Embolotherapy for persistent hemoptysis: the significance of pleural thickening.  Cardiovasc Intervent Radiol. 1993;  16 85-88
    PubMedGoogle Scholar
  • 31 Kato A, Kudo S, Matsumoto K et al.. Bronchial artery embolization for hemoptysis due to benign diseases: immediate and long-term results.  Cardiovasc Intervent Radiol. 2000;  23 351-357
    CrossrefPubMedGoogle Scholar
  • 32 Antonelli M, Midulla F, Tancredi G et al.. Bronchial artery embolization for the management of nonmassive hemoptysis in cystic fibrosis.  Chest. 2002;  121 796-801
    CrossrefPubMedGoogle Scholar
  • 33 Ramakantan R, Bandekar V G, Gandhi M S, Aulakh B G, Deshmukh H L. Massive hemoptysis due to pulmonary tuberculosis: control with bronchial artery embolization.  Radiology. 1996;  200 691-694
    CrossrefPubMedGoogle Scholar
  • 34 Cohen A M, Doershuk C F, Stern R C. Bronchial artery embolization to control hemoptysis in cystic fibrosis.  Radiology. 1990;  175 401-405
    CrossrefPubMedGoogle Scholar
  • 35 Tonkin I L, Hanissian A S, Boulden T F et al.. Bronchial arteriography and embolotherapy for hemoptysis in patients with cystic fibrosis.  Cardiovasc Intervent Radiol. 1991;  14 241-246
    CrossrefPubMedGoogle Scholar
  • 36 Hsu H K, Su J M. Giant bronchoesophageal fistula: a rare complication of bronchial artery embolization.  Ann Thorac Surg. 1995;  60 1797-1798
    CrossrefPubMedGoogle Scholar
  • 37 Munk P L, Morris D C, Nelems B. Left main bronchial-esophageal fistula: a complication of bronchial artery embolization.  Cardiovasc Intervent Radiol. 1990;  13 95-97
    CrossrefPubMedGoogle Scholar
  • 38 Helenon C H, Chatel A, Bigot J M, Brocard H. Left esophago-bronchial fistula following bronchial artery embolization [in French].  Nouv Presse Med. 1977;  6 4209
    PubMedGoogle Scholar
  • 39 Ivanick M J, Thorwarth W, Donohue J, Mandell V, Delany D, Jaques P F. Infarction of the left main-stem bronchus: a complication of bronchial artery embolization.  AJR Am J Roentgenol. 1983;  141 535-537
    PubMedGoogle Scholar
  • 40 Fitzgerald D B, Suran E L, Sargent J. Posterior circulation infarct after bronchial artery embolization and coiling.  Neurology. 2005;  65 1312
    CrossrefPubMedGoogle Scholar
  • 41 Chapman S A, Holmes M D, Taylor D J. Unilateral diaphragmatic paralysis following bronchial artery embolization for hemoptysis.  Chest. 2000;  118 269-270
    CrossrefPubMedGoogle Scholar
  • 42 Ramakantan R, Ketkar M, Maddali K, Deshmukh H. Referred pain to the ipsilateral forehead and orbit: an unusual phenomenon during bronchial artery embolization.  Cardiovasc Intervent Radiol. 1999;  22 275-277
    CrossrefPubMedGoogle Scholar
  • 43 Liu S F, Lee T Y, Wong S L, Lai Y F, Lin A S. Transient cortical blindness: a complication of bronchial artery embolization.  Respir Med. 1998;  92 983-986
    CrossrefPubMedGoogle Scholar
  • 44 Lemoigne F, Rampal P, Petersen R. Fatal ischemic colitis after bronchial artery embolization.  Presse Med. 1983;  12 2056-2057
    PubMedGoogle Scholar
  • 45 Jean-Baptiste E. Clinical assessment and management of massive hemoptysis.  Crit Care Med. 2000;  28 1642-1647
    CrossrefPubMedGoogle Scholar
  • 46 Saw E C, Gottlieb L S, Yokoyama T, Lee B C. Flexible fiberoptic bronchoscopy and endobronchial tamponade in the management of massive hemoptysis.  Chest. 1976;  70 589-591
    PubMedGoogle Scholar
  • 47 Tsukamoto T, Sasaki H, Nakamura H. Treatment of hemoptysis patients by thrombin and fibrinogen-thrombin infusion therapy using a fiberoptic bronchoscope.  Chest. 1989;  96 473-476
    CrossrefPubMedGoogle Scholar
  • 48 Magee G, Williams Jr M H. Treatment of massive hemoptysis with intravenous pitressin.  Lung. 1982;  160 165-169
    PubMedGoogle Scholar

Hsin-Yi LeeM.D. 

Department of Radiology, Mail code 114, VA Greater Los Angeles Healthcare System, West Los Angeles

11301 Wilshire Blvd., Los Angeles, CA 90073

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