Clinical application of transcatheter embolization in the treatment of acute massive hemoptysis

Objective: To evaluate the value of transcatheter embolization of bronchial arteries and/or non-bronchial systemic arteries for the treatment of hemoptysis using polyvinyl alcohol and/or detachable coils. Methods: Between January 2002 to October 2008, 20 patients with hemoptysis resulting from bronchoscopic biopsy of indeterminate lung nodules (n=1), lung cancer (n=4), tuberculosis (n=8), bronchiectasis (n=3) or sarcoidosis (n=4) underwent embolization of the bronchial arteries and non-bronchial systemic arteries responsible for the bleeding using detachable coils and/or polyvinyl alcohol (PVA). All of the patients were followed up for 1-23 months (average, 6 months). Results: In 20 patients, the success rate of the procedure was 95%. Hemoptysis was controlled in all patients within 24 hours of the embolization. Of four patients with recurrent hemoptysis, recanalization occurred in two patients who were embolized with only mechanical coils. In one patient with lung cancer and another patient with sarcoidosis, hemoptysis recurred because of recruitment of additional feeding arteries as well as non-embolization of a large feeding artery originating from the subclavian artery. No major complications were encountered. Conclusion: In patients with hemoptysis, preoperative multi-slice CT angiography and thoracic aortography can demonstrate the arteries contributing to hemoptysis. Embolization of the bronchial arteries and/or non-bronchial systemic arteries with only coils is liable to early recurrence of hemoptysis. Embolization with combination of PVA and coils may result in immediate and long-term control of hemoptysis. (authors)