Recurrent bleeding after arterial embolization in patients with hemoptysis

Thirty-three patients with hemoptysis caused by nonmalignant diseases underwent arterial embolization. In seven (21.2 percent) of 33 patients, hemoptysis recurred after initial embolization in a follow-up period ranging from one day to four years. Although there was no difference in age and daily quantity of bleeding among patients with and without recurrences, those with mycetoma suffered the highest recurrence of bleeding after initial embolization (three [75 percent] of four patients). In the initial arteriograms of the seven patients were found six cases of markedly increased vascularity, three of increased vascularity in the bilateral lung, and three of nonbronchial systemic arterial supply to the diseased lung. Of six patients who received reexamination at the time of recurrent bleeding, the arteriogram demonstrated recanalization of previously embolized artery in five and revascularization by collateral circulation in five. In addition, hemoptysis recurred in three (60 percent) of five patients after second embolization and in one (50 percent) of two after third embolization. Four patients underwent surgical therapy: two after the initial embolization, one after the second, and one after the third, and these patients had no recurrence. While arterial embolization as initial treatment of hemoptysis is a highly useful procedure, this is a palliative procedure and potential for recurrence of hemoptysis exists as the lesion that has initially caused hemoptysis is not cured by the embolization. We emphasize that a combination therapy of repeated embolization and surgery will probably improve the efficacy of treatment of recurrent bleeding after initial embolization.