Bronchial artery embolization for the treatment of hemoptysis: permanent versus temporary embolic materials, a single center study.

Abstract

Background: Bronchial artery embolization (BAE) is a common interventional radiology technique used to control significant bleeding from the bronchial circulation, especially in cases of severe hemoptysis or pulmonary hemorrhage. The choice of embolizing agents plays a key role in the success, recurrence of bleeding, and safety of the procedure. However, there is no consensus on the ideal embolizing agent. This study compares the efficacy, safety, and long-term outcomes of using permanent versus temporary embolizing agents in BAE.

Methods: This retrospective cohort study included patients who underwent BAE at our institution from July 2006 to May 2024. Inclusion criteria encompassed patients with hemoptysis requiring intervention, complete clinical and radiological data, and BAE with either permanent (e.g., coils, PVA particles) or temporary (e.g., gelatin sponge) embolic materials. Exclusion criteria included non-bronchial causes of hemoptysis, BAE as part of a lung transplant protocol, or use of combined embolic materials. Primary outcomes included early clinical success (cessation of bleeding during the procedure and no recurrence within a week) and late clinical success (no bleeding recurrence within 6 months). Secondary outcomes focused on procedural complications, such as pneumonia, lung infarction, or bronchial ischemia.

Results: This retrospective study included a total of ninety-four procedures performed in eighty-five patients (56 males, 29 females; mean age 59; age range 8-92 years) who were admitted for BAE between July 2006 and May 2024. Permanent embolic materials were used in 59 procedures (64%), in most cases were used particles and glue (39% and 21%, respectively), while temporary embolizing materials (gelatin sponge) were used in 35 procedures (37%). Statistical analysis showed a superiority in terms of clinical outcomes in favor of permanent embolic materials (p-value 0,047).

Conclusions: BAE is a safe procedure for control of hemoptysis of varying etiologies and possesses high rates of immediate clinical success with few complications. In terms of embolic materials, a superiority in term of late clinical success and lower hemorrhage recurrency rate with permanent materials were clearly observed in our population, with a similar safety profile. Further studies are needed to confirm our findings and strengthen evidence.