Selective bronchial artery embolization for the treatment of cryptogenic hemoptysis

Objective: To analyze the bronchial artery angiographic findings of cryptogenic hemoptysis and to assess the clinical value of selective bronchial artery embolization (BAE) in treating cryptogenic hemoptysis. Methods: During the period from June 2004 to March 2011, selective bronchial artery embolization (BAE) was adopted in 11 patients with uncontrollable cryptogenic hemoptysis. Systemic aortic angiography and subclavian artery angiography were performed during BAE procedure to confirm the feeder vessel and its origin. The bronchial arteries (BA) and non-bronchial systemic arteries (NBSA) that were responsible for hemoptysis were embolized with PVA particles (350-750 μm). The clinical results and complications were documented. All the patients were followed up for 6 months to 5 years. Results: Ten of the 11 patients (10 males and one female) were smokers. No pulmonary parenchymal lesions were detected by preoperative enhanced computed tomography and by fiberoptic bronchoscope. Angiography showed that vascular abnormality was seen in 10 of the 11 patients, and a total of 24 responsible feeder vessels were verified, including right bronchial artery (n=11), left bronchial artery (n=8), internal mammary artery (n=2) and intercostal artery (n=3). In 8 patients the hemoptysis ceased immediately after BAE. In two patients a small amount of hemoptysis remained, which was improved after conservative treatment. One patient still had active hemoptysis after BAE and pulmonary lobectomy had to be carried out. Postoperative complications included different degrees of chest pain (n=2), fever (n=1) and mild renal insufficiency (n=1), which were relieved after clinical management. No serious post-embolization complications occurred. No recurrence of hemoptysis was observed within one month after BAE. In one patient the hemoptysis reappeared five months after the treatment, and the bronchial bleeding ceased after conservative therapy. All patients were followed up for at least 6 months and no pulmonary malignancy was detected by CT scans. Conclusion: Smoking is one of the main risk factors for cryptogenic hymoptysis. Bronchial arteries are the primary feeder vessels in cryptogenic hemoptysis. Selective bronchial artery embolization is a highly effective and safe treatment for cryptogenic hemoptysis and this technique should be regarded as the therapy of first choice. (authors)