Highlights
- •Bronchial artery hypertrophy is observed in many patients with CTEPH.
- •Retrospective review 367 CTEPH patients, 3 massive hemoptysis and bronchial artery embolization.
- •Technical success 100%. No hemoptysis recurrence was demonstrated at follow-up.
- •BAE in patients with CTEPH allows continuation or early re-establishment of anticoagulation.
Abstract
Introduction
In many patients with Chronic Thromboembolic Pulmonary Hypertension (CTEPH), bronchial
artery hypertrophy is observed. Patients with bronchial dilatation have been shown
to be at increased risk of hemoptysis introducing the risk of airway obstruction.
In this study from an academic tertiary referral center, we aimed to assess the incidence
of massive hemoptysis in our CTEPH patients, the success of bronchial artery embolization
(BAE), recurrence, and hemoptysis-related mortality.
Methods
Retrospective cohort study of all adults with CTEPH who underwent BAE for massive
hemoptysis between 1 January 2015 and 30 July 2021. Primary endpoints were hemoptysis
relapse and hemoptysis-related mortality.
Results
There were 367 patients who were being treated and managed with a diagnosis of CTEPH
at our institution. There were 24 bronchial artery embolization procedures performed
for all causes. A total of 3 patients during this time met inclusion criteria with
acute massive hemoptysis and CTEPH. All patients were taking therapeutic-dose anticoagulation.
Technical success after BAE was 100%. No hemoptysis recurrence was demonstrated at
17, 24, and 40-months follow-up respectively. No patient died from hemoptysis. However,
1 patient died 24 months after the embolization procedure due to a non-hemoptysis
cause.
Conclusion
This study highlights the low but important incidence of massive hemoptysis in patients
with CTEPH. Unlike other causes of hemoptysis, this unique cohort requires balancing
anticoagulation and hemorrhage control. Given the high degree of success, BAE is a
viable option, allowing continuation or early re-establishment of anticoagulation.
Keywords
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Article info
Publication history
Published online: February 24, 2022
Accepted:
February 20,
2022
Received in revised form:
January 16,
2022
Received:
September 19,
2021
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
