Abstract
Thirty-one patients presenting hemoptysis were treated by transcatheter arterial embolization (TAE) of the bronchial artery and other arteries. Gelfoam particles were used for embolization in all cases with additional use of Ivalon particles, coils and Lipiodol-fibrin adhesive mixture in a small number of cases.
Angiographic evaluation of the bronchial artery anatomy revealed eleven different patterns, with intercostobronchial trunk (ICBT) in 48% and truncus communis in 64% of cases. Peripheral hypervascularity with increased caliber of the bronchial artery (94%) and broncho-pulmonary shunt (68%) were the most common angiographic findings on bronchial arteriography (BAG) in patients with hemoptysis, and these findings were considered to indicate arteries to be embolized.
Systemic feeders other than bronchial artery were found in 52% of 31 patients, especially in cases with pleural thickening and adhesion, and those with widespread bronchiectasis. The role of the esophageal artery in cases with widespread bronchiectasis especially involving the left lower lobe was stressed as a new angiographic finding.
Good control of hemoptysis was achieved in 23 of 26 patients (88%) after TAE. Five patients were excluded from the evaluation of the efficacy of TAE because of intermittent episodes of hemoptysis or possible effective medical control before embolization. Among the patients with effective embolization, 5 cases (21%) recurred within one month after embolization, and 6 out of 18 patients (33%) showed recurrence of hemoptysis during the long-term follow-up ranging from 1-46 months.
The major reasons for recurrence were superimposed infection, the existence of many systemic feeders and recanalization of embolized arteries. Most of these patients were controlled by additional TAE or medical treatment.
Most of the complications related to TAE were mild and insignificant especially in BAE. However, we experienced one case of spinal cord ischemia following embolization of intercostal arteries which was not directly related to the anterior spinal artery.
