Outcomes of bronchial artery embolization for life-threatening hemoptysis due to tuberculosis and post-tuberculosis sequelae

PURPOSE To determine the long-term outcomes of bronchial artery embolization in patients with massive hemoptysis due to pulmonary tuberculosis and post-tuberculosis sequelae and to study the factors influencing success. MATERIALS AND METHODS In this study, 58 patients underwent 64 bronchial artery embolizations for massive hemoptysis due to tuberculosis or its sequelae between 1998 and 2008. Their images and procedure details were reviewed. Medical records and direct contact were used to obtain information on outcome. The cumulative hemoptysis control rate per follow-up interval was calculated. RESULTS The data showed that 25 patients presented with acute massive hemoptysis and 33 presented with chronic recurrent hemoptysis. The median quantity of blood was 400 mL (range, 70-2000 mL). The median follow-up period was 432 days (range, 11-1789 days). Twenty-seven patients had recurrence after a median period of 110 days after the procedure (range, 1-959 days). The hemoptysis control rate was 93% at 2 weeks, 86% at one month, 79.5% at 3 months, 63% at 6 months, 51% at one year and 39% at 2 years. Six patients underwent repeat procedures. Chest pain was the most common procedure-related complication (n=20, 34.5%); there was no spinal cord complication or mortality. There were seven deaths, five of which were related to hemoptysis. Nine patients were lost to follow-up. Lung cavities (P = 0.08), non-bronchial systemic artery collaterals (P = 0.081) and systemic-to-pulmonary venous shunts (P = 0.053) were more common in those who experienced recurrence. CONCLUSION Bronchial artery embolization is a relatively safe procedure that is lifesaving in patients who are not suitable for surgery. However, the associated long-term outcome is less satisfactory.