Long-Term Results of Bronchial Artery Embolization in Patients with Hemoptysis in a Quaternary Hospital in India

Purpose: To review the long-term results and complications of patients who underwent Bronchial artery embolization in a quaternary hospital in India over 7 years.

Materials and Methods: We present a retrospective review of patients who underwent BAE at a tertiary care hospital over the last seven years. Relevant data (demographics, indication, underlying disease, clinical presentation, preoperative imaging, bronchial artery anatomy, technique, results, complications, and clinical outcome) were collected and analyzed.

Results: A total of 72 procedures were performed in 70 patients (56 males, 14 females), ages ranging from 20 to 90 years, and the peak incidence was noted in the age group between 60 and 70 years (34% cases). 48% of patients presented with massive hemoptysis. Clinical diagnosis of tuberculosis was made in 54% of patients, followed by fungal infections in 17%, 7% in bacterial infections, 4% secondary to carcinomas, and 10% in other causes like systemic lupus erythematosus, Wegner's granulomatosis, and arterio-venous malformations. (1) Lung parenchymal changes and bronchial/nonbronchial systemic artery anatomy were assessed in CT scan imaging. Bronchiectasis was the most common lung finding (44%), followed by lung consolidation (14%) and prior infective changes(17%). Alveolar hemorrhage was noted in 11%, and lung cavitations were noted in 8% of patients. Hypertrophied bronchial arteries were documented in 79% of the patients, while normal-sized bronchial arteries were reported in 21%. (2) Bronchial angiogram showed hypertrophied bronchial arteries in 92% of the cases, while 8% showed normal-sized vessels. Ectopic origin of bronchial arteries was noted in 28% of the cases. 78% of the cases showed bronchopulmonary communications, bronchial artery pseudoaneurysms in 5%, and Rasmussen aneurysms in 2%. In this cohort, 92% of the origin of bronchial arteries was noted from the right intercostal bronchial trunk, followed by the right bronchial artery in 68% and 42% in the left bronchial artery. Ectopic origin of bronchial arteries was seen in 21%, most commonly from inferior phrenic arteries followed by subclavian arteries. (3) Among the 72 cases, in 70%, the primary choice of catheter was Amplatz left (AL1), followed by Cobra in 21%. Simmons catheter (SIM1) was used in 2 cases, RIM in 3 cases (ectopic origin), and VERT catheter in 1 case. The choice of embolic was PVA particles in 92% of the cases, followed by micro-coils in 21% of the cases where abnormal bronchopulmonary communications were seen with drainage into the pulmonary venous system. Glue was used in 2 cases, and gel foam in 7% of the cases. (4) The procedure was uneventful in 94% with no significant complications. One patient each had the following complication: access site hematoma, pseudoaneurysm, nontarget embolization, including cerebrovascular accident. Chest pain requiring analgesia occurred after 12% of Procedures.

Publication History

Article published online:
02 April 2024