Purpose: To systematically review role of bronchial artery embolization (BAE) in hemoptysis.
Methods: Literature search was done for studies on BAE published between 1976 to 2016. Studies published in English, with sample size of at least 50 patients, and reporting indications, technique, efficacy and follow-up were considered for analysis.
Results: Twenty-two studies were included for final analysis. Common indications for BAE included tuberculosis (TB), post-tubercular sequelae, bronchiectasis and aspergillomas. Most common embolizing agent used was polyvinyl alcohol (size 300-600 μ) with increasing use of glue in recent years. Overall immediate clinical success rate of BAE, defined as complete cessation of hemoptysis, varied from 70-99%. However recurrence rate remains high, ranging from 10-57%, due to incomplete initial embolization, recanalization of previously embolized arteries and recruitment of new collaterals. Presence of non-bronchial systemic collaterals, broncho-pulmonary shunting, aspergillomas, reactivation TB and multidrug resistant TB were associated with significantly higher recurrence rates (P < .05). Rate of major complications remained negligible and stable over time with median incidence of 0.1% (0-6.6.%).
Conclusion: Despite high hemoptysis recurrence rates, BAE continues to be the first-line, minimally invasive treatment of hemoptysis in emergency settings, surgically unfit patients or in patients with diffuse or bilateral lung disease.