Indicators predictive of success of embolisation: analysis of 88 patients with haemoptysis

To identify the risk factors related to relapse of haemoptysis in patients treated with arterial embolisation.

Eighty-eight patients with haemoptysis (60 M, 28 F; average age 58.9) were examined by bronchial arteriography: 64/88 were subsequently embolised. The clinical and angiographic parameters, immediate and long-term results were analysed. Follow-up ranged from 8 days to 104 months. No major complications were observed.

Patients treated with embolisation (64/88= 72.7%) were divided into two groups. Group 1 (23/64= 35.9%) included patients with relapse of haemoptysis and Group 2 (41/64=64.1%) patients without recurrence during follow-up. In all 64 patients with haemoptysis, embolisation succeeded in stopping the haemorrhage, long-term efficacy was observed in 64.1%; when the treatment was repeated, secondary success was 68.75%. Recurrence after embolisation was correlated to chronic lung disease (p=0.04) especially to pulmonary tuberculosis or mycetoma (p=0.007) and to systemic-pulmonary shunts (p=0.02). The absence of a history of massive haemoptysis was related to a greater likelihood of non-recurrence (p=0.0035). Moreover, complicated tuberculous lesions (Log-rank test p=0.0027), chronic lung disease (p=0.0272) and systemic-pulmonary shunts (p=0.0406) were predictive of an earlier relapse (Kaplan Meier curves and Log-rank test). Comparison of tuberculosis and/or mycetoma with systemic-pulmonary shunting showed the greater impact of infectious lesions on early recurrence.

Embolisation of abnormal vascularisation, which can be repeated in cases of failure, proved successful in patients with haemoptysis showing definitive or long-term resolution of the clinical picture in about 70% of cases. Patients with tuberculosis or mycetoma with systemic-pulmonary shunting and haemodynamic alterations have a higher risk of early recurrence.