[Embolization of bronchial arteries in severe and recurrent hemoptysis]

Bronchial artery embolization is an established treatment for massive and serious haemoptysis. We review etiology, pathogenesis and different treatment modalities of major haemoptysis, and discuss indications and outcome. Massive haemoptysis, defined as > 300 ml/24 hrs., is a rare condition with a high mortality rate (30-80%) if treated conservatively. We describe seven patients treated with bronchial artery embolization. Three patients had massive haemoptysis, and four patients were treated for recurrent and severe haemoptysis. Two patients had haemorrhage because of inactive tuberculosis, five had cystic fibrosis. All patients were successfully treated by embolization, one patient suffered recurrent haemoptysis after four weeks. The other patients have shown no further haemoptysis during the observation period (mean 20 months). No complications were observed other than the common, self-limited post-embolization syndrome (mild fever and chest pain). In patients with severely reduced lung function and progressive disease, recurrent haemoptysis of even smaller amounts might interfere with postural drainage and cause infections and deteriorate lung function. Bronchial artery embolization should be considered for these patients as well. Unless localized lesions can be cured through surgical resection, we consider bronchial artery embolization to be the treatment of choice.