From the Guidelines
Bronchial artery embolization (BAE) is primarily indicated for the management of massive hemoptysis, typically defined as expectoration of more than 100-300 mL of blood within 24 hours, as well as for recurrent hemoptysis, according to the most recent guidelines 1. The procedure is recommended for patients with hemoptysis that is life-threatening, recurrent, or refractory to conservative management. Specific indications include:
- Hemoptysis due to bronchiectasis
- Tuberculosis (active or sequelae)
- Aspergillomas
- Lung cancer
- Arteriovenous malformations BAE may also be considered in patients with:
- Cystic fibrosis
- Sarcoidosis
- Broncholithiasis complicated by bleeding The procedure involves selective catheterization of bronchial arteries followed by injection of embolic materials such as polyvinyl alcohol particles (300-500 μm), gelatin sponge, or microcoils to occlude the bleeding vessels. Prior to the procedure, imaging with CT angiography is essential to identify the source of bleeding and map the bronchial arterial anatomy, as recommended by recent studies 1. BAE is effective because most cases of massive hemoptysis (90%) originate from the bronchial circulation rather than the pulmonary circulation. The procedure carries a technical success rate of 70-99% with immediate control of bleeding, though recurrence may occur in 10-30% of cases, necessitating repeat embolization, as reported in recent studies 1. Potential complications include transient chest pain, dysphagia, bronchial necrosis, and rarely, spinal cord ischemia if spinal arteries are inadvertently embolized. In cases of aspergilloma, surgical removal is considered the definitive treatment, but BAE may be useful as a temporizing procedure in patients with life-threatening hemoptysis, according to older guidelines 1. However, the most recent guidelines prioritize BAE as the first-line therapy for massive hemoptysis, including those who will eventually be definitively treated with surgery 1.
From the Research
Indications for Bronchial Artery Embolization
The primary indication for bronchial artery embolization (BAE) is the treatment of hemoptysis, which is a common complication in patients with cystic fibrosis (CF) 2, 3, 4. Hemoptysis can range from minor blood-streaking of sputum to life-threatening bleeding, and BAE is often used to control major hemoptysis, defined as bleeding greater than 240 ml/24 h 2.
Etiologies of Hemoptysis
Hemoptysis can be caused by various etiologies, including:
- Cystic fibrosis (CF) 2, 3, 4
- Post-tubercular sequalae 5
- Idiopathic bronchiectasis 5
- Aspergilloma 5
- Other conditions that cause bronchial artery hypertrophy and bleeding 6
Effectiveness of BAE
BAE has been shown to be a safe and effective procedure for the treatment of hemoptysis, with immediate clinical success rates ranging from 85% to 100% 6. The overall efficacy of BAE for initial control of hemoptysis was 75% after one session, 89% after two sessions, and 93% after three sessions 2. However, recurrence rates can be high, ranging from 10% to 33% 6, and have been reported to be as high as 46% in patients with CF 2.
Predictive Factors for Recurrence
Several factors have been identified as predictive of recurrent hemoptysis after BAE, including: