Outcomes of Bronchial Artery Embolization in Patients With Moderate to Severe Hemoptysis: A Longitudinal Study From a Tertiary Care Center.

BACKGROUND

Hemoptysis, particularly in its moderate to severe forms, is a life-threatening respiratory emergency with multiple underlying etiologies, including post-tuberculosis sequelae, bronchiectasis, and aspergilloma. Bronchial artery embolization (BAE) has emerged as a first-line, minimally invasive intervention for controlling bleeding, but long-term outcomes and recurrence rates vary across populations, particularly in tuberculosis-endemic regions.

METHODS

This longitudinal observational study was conducted over 18 months at a tertiary care center, enrolling 203 patients aged 18 years or older presenting with moderate to massive hemoptysis. All patients underwent clinical evaluation, radiological imaging, and BAE using Embox (Meril Life Sciences Pvt. Ltd., Vapi, India). Demographics, etiology, vessel involvement, immediate and follow-up outcomes at one and three months, and complications were recorded. The primary endpoint was immediate clinical success (bleeding cessation within 24 hours), while secondary endpoints included recurrence, treatment failure, and complication rates.

RESULTS

Moderate hemoptysis was observed in 119 (58.6%) patients, while massive hemoptysis occurred in 84 (41.4%). Aspergilloma was the most common underlying etiology, identified in 89 (43.8%) cases, followed by bronchiectasis in 39 (19.2%) and fibrocavitary lesions in 24 (11.8%). Bilateral bronchial artery involvement was seen in 64 (27.8%) patients. The overall immediate clinical success rate was 151 (74.3%), whereas recurrence or treatment failure occurred in 22 (10.8%) patients, and mortality was reported in seven (3.4%) cases. Postprocedural complications were common, with chest pain in 119 (58.6%) and fever in 30 (14.8%) patients. Severe neurological events were rare, occurring in only one patient (0.5%). Most complications were self-limiting and showed a declining trend over time.

CONCLUSION

BAE is an effective and relatively safe intervention for controlling moderate to massive hemoptysis, particularly in patients with post-tuberculosis sequelae. Although recurrence and minor complications are common, BAE offers a valuable treatment modality in both emergency and elective settings, especially for patients unfit for surgery.