Purpose: To investigate whether pre-procedure Computed Tomography Angiography (CTA) improves radiation exposure and symptom recurrence after bronchial embolization for massive hemoptysis.
Material and Methods: A single-center retrospective review of bronchial artery embolization (BAE) for massive hemoptysis was performed for procedures between 2008-2019. For patients undergoing multiple procedures, the first procedure was analyzed. Patients with ancillary procedures at time of BAE were excluded. Multi-variate analysis was performed to determine the significance of pre-procedure CTA and etiology of hemoptysis on patient radiation exposure (reference point air kerma, RPAK) and rate of recurrent hemoptysis.
Results: There were 61 patients (mean age 52.5 years; SD=19.2 years, and 58.3% male) who underwent 87 BAE procedures. Pre-procedure CTA was obtained for 42.6% (26/61) of patients. Number of vessels selected was a mean of 7.2 (SD=3.4) in those without CTA and 7.4 (SD=3.4) in those with CTA (p=0.923). Mean procedure duration was 1.8 hours (SD=1.6 hours) in those without CTA and 1.3 hours (SD=1.0 hours) in those with CTA (p=0.466). Mean fluoroscopy time and RPAK per procedure were 34.9 minutes (SD=21.5 minutes) and 1091.7 mGy (SD=1316.6 mGy) for those without a CTA and 30.7 minutes (SD=30.7 minutes) and 771.5 mGy (SD=590.0 mGy) for those with a CTA (p=0.523, and p=0.879, respectively). If the CTA is included, the mean total iodine given was 49.2 gms (SD=31.9 gms) for those without a CTA and 70.6 gms (SD=24.9 gms) for those with a CTA (p=0.001). Ongoing hemoptysis at last clinical follow up was 13/35 (37.1%) in those without CTA and 9/26 (34.6%) in those with pre-procedure CTA (p=0.794). The most common etiologies of massive hemoptysis for BAE were malignancy (n=13), cystic fibrosis (n=12), chronic infections (n=12), and chronic obstructive pulmonary disease (n=11). Multi-variate analysis of the etiology of BAE failed to demonstrate benefit with pre-procedure CTA.
Conclusions: Pre-procedure CTA did not improve radiation exposure and symptom recurrence after BAE and is associated with statistically significant increases in total iodine dose.