1Puneet Garg,1Ayush Khandelwal, 1Ayush Khandelwal, 1Amita Malik
1VMMC & Safdarjung Hospital
Bronchial artery embolization (BAE) is a minimally invasive endovascular procedure which plays a vital role in patients of moderate to massive hemoptysis who can not be managed with conservative measures. Superselective embolization of culprit vessels with PVA particles is a promising technique to give symptomatic relief for hemoptysis and can be used as an adjunctive treatment alongwith surgery and medications to reduce the morbidity of such patients. BAE can also be considered as life saving procedure in cases of life threatening hemoptysis.
Material(s) and Method(s):
Patients of moderate to massive hemoptysis and patients of mild chronic hemoptysis not controlled on medications were included in the study from 2018 to 2021. BAE was done in DSA suite using PVA particles as embolizing agent. Technical success,complications and clinical success rates at 1month, 3 months and 6 months follow up.
130 patients were included in the study and 95 were males in that cohort. 43 patients had mild hemoptysis, 46 had moderate and 41 had massive category of hemoptysis with duration of symptoms ranging from 3 days to 25 years. Posterior intercostal artery was the most common culprit vessel followed by Intercostobronchial trunk. Hypervascularity was the most common angiographic finding followed by hypertrophy and tortuosity. Average of 2.5 culprit arteries were embolized per patient with range varying from 1 to 8. Technical success was achieved in 98 % of the patients. 96%, 91%, 82% and 67% clinical success rate was observed at immediate, 1 month, 3 months and 6 months follow up. 4 patients were stablized after life threatening hemoptysis episode with this procedure. Spinal cord ischemia was the most severe complication observed in one patient and chest pain was most common minor side effect of the procedure.
BAE is a safe, prompt and effective procedure to control hemoptysis in all categories of hemoptysis refractory to medical management. It can also be a life saving procedure when other modalities have failed or warrants immediate treatment.