| Transcatheter arterial embolization in the treatment of massive hemoptysis. |
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Won Young Choi1, Jin Won Choi1, Byung Sung Lim1, Dong Ho Shin1, Sung Soo Park1, Jung Hee Lee1, Heung Suk Seo2 |
1Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
2Department of Diagnostic Radiology, College of Medicine, Hanyang University, Seoul, Korea |
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| Abstract |
Background
Massive hemoptysis is a major clinical and surgical problem related to high motality. 8ronchial and nonbronchial systemic arteries are considered to be the main source of hemoptysis. Embolization of these arteries has become an accepted treatment in the management of massive hemoptysis.
Herein we evaluate the effect of arterial embolization in immediate control of massive hemoptysis and investigate the clinical and angiographic characteristics and the course of patients with recurrent hemoptysis after initial successful embolization.
MethodS
21 patients (15 men & women, aged 21 to 74 years) underwent transcatheter arterial embolization for the treatment of life-threatening massive hemoptysis from Jan 1988 to July 1991. Seven patients had inactive residual pulmonary tuberculosis, 5 cases aspergilloma, 4 cases active pulmonary tuberculosis, 3 cases bronchiectasis and 2 case lung cancer. Arteriography was done by percutaneous catheterization via the femoral artery, and at the same time, arterial embolization was done with gelfoam particle.
Result
Immediate control of massive hemoptysis was achieved in all 21 cases by arterial embolization. Hemoptysis recurred in nine of 21 patients. Four cases were aspergilloma , two inactive tuberculosis, two lung cancer, and one bronchiectasis. The initial angiographic findings revealed that nonbronchial systemic arterial supply, bronchial-pulmonary arterial shunt, and marked vascularity were more frequently , but statistically insignificant, in recurred patients. The following complications occured: fever, chest pain, cough, voiding difficulty , paralytic ileus, paraplegia, and splenic infarction.
The course of the recurred patients was as follows:
Three patients were died due to recurred massive hemoptysis. one was aspergilloma and two lung cancer‘ Surgical resection could be performed successfully in two patient with relatively good lung function. one aspergilloma and the other inactive tuberculosis. In 4 patients with poor lung function .
repeated embolization or medical conservative treatment was continued.
Conclusion
Arterial embolization as initial treatment of massive hemoptysis is most useful and relatively safe. although this is a palliative procedure and the potentiality for recurrence exists.
Repeated embolization in inoperable patient with recurrent bleeding may improve the lengthening of life. |
| Key Words:
Hemoptysis, Bronchial artery, Embolization |
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