Hemoptizi Yönetiminde Bronşiyal Arter Embolizasyonu: Tanıdan Tedaviye Güncel Yaklaşım
Özet
Hemoptizi, trakeobronşiyal sistem veya pulmoner parankim kaynaklı kanın öksürükle dışarı atılması ile karakterize, potansiyel olarak yaşamı tehdit eden bir klinik durumdur. Olguların çoğu hafif ve kendini sınırlayıcı olsa da bazı hastalarda acil müdahale gerektiren ciddi kanama gelişebilir. Vakaların yaklaşık %90’ında kanama bronşiyal arter dolaşımından kaynaklanır ve bu durum genellikle kronik inflamasyon, neovaskülarizasyon ve sistemik arter hipertrofisi ile ilişkilidir. Bronşiyal arter embolizasyonu (BAE), masif veya rekürren hemoptizi tedavisinde günümüzde en önemli minimal invaziv yöntemlerden biri haline gelmiştir. Bilgisayarlı tomografi anjiyografi (BTA) ve endovasküler tekniklerdeki gelişmeler tanısal doğruluğu ve işlem planlamasını önemli ölçüde iyileştirmiştir. İşlem öncesi BTA değerlendirmesi bronşiyal ve non-bronşiyal sistemik arterlerin saptanmasını sağlayarak selektif ve süperselektif kateterizasyonu kolaylaştırır. BAE genellikle femoral arter erişimi ile gerçekleştirilir ve mikrokateterler kullanılarak patolojik damarların distal kateterizasyonu sağlanır. Polivinil alkol partikülleri, kalibre mikrosferler ve N-butil siyanoakrilat gibi embolizan ajanlar kalıcı damar oklüzyonu sağlamak amacıyla kullanılır. Erken klinik başarı oranları %82–100 arasında bildirilmiştir; ancak inkomplet embolizasyon veya kollateral damar gelişimine bağlı rekürrens görülebilir. Modern süperselektif teknikler ve dikkatli anatomik değerlendirme sayesinde komplikasyon riski belirgin şekilde azalmıştır. BAE, hayatı tehdit eden veya tekrarlayan hemoptizi olgularında güvenli ve etkili bir birinci basamak tedavi yöntemidir.
Hemoptysis is a potentially life-threatening condition characterized by the expectoration of blood originating from the tracheobronchial tree or pulmonary parenchyma. Although most cases are mild and self-limited, a subset of patients develop severe bleeding requiring urgent intervention. Approximately 90% of cases arise from the bronchial arterial circulation due to chronic inflammation, neovascularization, and systemic arterial hypertrophy. Bronchial artery embolization(BAE) has become the primary minimally invasive treatment for massive or recurrent hemoptysis. Advances in computed tomography angiography (CTA) and endovascular techniques have improved both diagnostic accuracy and procedural planning. Pre-procedural CTA enables identification of bronchial and non-bronchial systemic arteries, guiding selective and superselective catheterization during embolization. The procedure is typically performed via femoral arterial access using microcatheters to achieve distal catheterization of pathological vessels. Embolic agents such as polyvinyl alcohol particles, calibrated microspheres, and N-butyl cyanoacrylate are commonly used to obtain durable vascular occlusion. Immediate clinical success rates range from 82% to 100%, although recurrence may occur due to incomplete embolization or collateral vessel formation.Despite potential complications, including spinal cord ischemia from non-target embolization, modern superselective techniques and careful anatomical evaluation have significantly reduced these risks. Overall, BAE is a safe and effective first-line treatment for life-threatening or recurrent hemoptysis.
Referanslar
Abdulmalak C, Cottenet J, Beltramo et al. Haemoptysis in adults: a 5-year study using the French nationwide hospital administrative database. European Respiratory Journal. 2015;46(2):503-11.
Ittrich H, Bockhorn M, Klose H. The Diagnosis and Treatment of Hemoptysis. Dtsch Arztebl Int. 2017;114(21):371-81.
Kathuria H, Hollingsworth HM, Vilvendhan R et al. Management of life-threatening hemoptysis. J Intensive Care. 2020;8(1):23.
Davidson K, Shojaee S. Managing Massive Hemoptysis. Chest. 2020;157(1):77-88.
Prey B, Francis A, Williams J, et al. Evaluation and Treatment of Massive Hemoptysis. Surgical Clinics of North America. 2022;102(3):465–81.
Ravetta P, Bruyneel M, Vouche M. New insights on Bronchial Artery Embolization (BAE) for hemoptysis: a systematic review. BMC Pulm Med. 2025;25(1):541.
Kaufman CS, Kwan SW. Bronchial Artery Embolization. Semin Intervent Radiol. 2022;39(03):210-7.
Radchenko C, Alraiyes AH, Shojaee S. A systematic approach to the management of massive hemoptysis. J Thorac Dis. 2017;9(S10):S1069-86.
Kettenbach J, Ittrich H, Gaubert JY et al. CIRSE Standards of Practice on Bronchial Artery Embolisation. Cardiovasc Intervent Radiol. 2022;45(6):721-32.
Chun JY, Morgan R, Belli AM. Radiological Management of Hemoptysis: A Comprehensive Review of Diagnostic Imaging and Bronchial Arterial Embolization. Cardiovasc Intervent Radiol. 2010;33(2):240-50.
McDONALD DM. Angiogenesis and Remodeling of Airway Vasculature in Chronic Inflammation. Am J Respir Crit Care Med. 2001;164:39-45.
Yoon W, Kim JK, Kim YH et al. Bronchial and Nonbronchial Systemic Artery Embolization for Life-threatening Hemoptysis: A Comprehensive Review. RadioGraphics. 2002;22(6):1395-409.
CAULDWELL EW, SIEKERT RG. The bronchial arteries; an anatomic study of 150 human cadavers. Surg Gynecol Obstet. 1948;86(4):395-412.
Guan JJ. Bronchial Artery Embolization. In: Essential Interventional Radiology Review. Cham: Springer International Publishing; 2022;733–45.
Panda A, Bhalla AS, Goyal A. Bronchial artery embolization in hemoptysis: a systematic review. Diagnostic and Interventional Radiology. 2017;23(4):307-17.
Guzelbey T, Arslan MF, Cingoz M et al. Efficacy and safety of particle embolization in bronchial arteries of hemoptysis patients with shunts. Clin Radiol. 2024;79(9):704-10.
Hwang JH, Kim JH, Park S et al. Feasibility and outcomes of bronchial artery embolization in patients with non-massive hemoptysis. Respir Res. 2021;22(1):221.
García Jurado PB, Pérez Montilla ME, Lombardo Galera MS et al. Embolización de arterias bronquiales y arterias sistémicas no bronquiales con n-butil-cianoacrilato en pacientes con hemoptisis: un estudio monocéntrico y retrospectivo. Radiologia. 2023;65(2):99-105.
Woo S, Yoon CJ, Chung JW et al. Bronchial Artery Embolization to Control Hemoptysis: Comparison of N -Butyl-2-Cyanoacrylate and Polyvinyl Alcohol Particles. Radiology. 2013;269(2):594-602.
Ryuge M, Hara M, Hiroe T et al. Mechanisms of recurrent haemoptysis after super-selective bronchial artery coil embolisation: a single-centre retrospective observational study. Eur Radiol. 2019;29(2):707-15.
Bhalla A, Kandasamy D, Veedu P et al. A Retrospective Analysis of 334 Cases of Hemoptysis Treated by Bronchial Artery Embolization. Oman Med J. 2015;30(2):119-28.
Marcelin C, Soussan J, Desmots F et al. Outcomes of Pulmonary Artery Embolization and Stent Graft Placement for the Treatment of Hemoptysis Caused by Lung Tumors. Journal of Vascular and Interventional Radiology. 2018;29(7):975-80.
Ostrowski P, Bonczar M, Glądys K, et al. The complex anatomy of the bronchial arteries: a meta-analysis with potential implications for thoracic surgery and hemoptysis treatment. Sci Rep. 2024;14(1):30942.
van den Heuvel MM, Els Z, Koegelenberg CF, Naidu KM et al. Risk factors for recurrence of haemoptysis following bronchial artery embolisation for life-threatening haemoptysis. Int J Tuberc Lung Dis. 2007;11(8):909-14.
Ishikawa H, Ohbe H, Omachi N et al. Spinal Cord Infarction after Bronchial Artery Embolization for Hemoptysis: A Nationwide Observational Study in Japan. Radiology. 2021;298(3):673-9.
Lee HN, Park HS, Hyun D et al. Combined therapy with bronchial artery embolization and tranexamic acid for hemoptysis. Acta radiol. 2021;62(5):610-8.
Fruchter O, Schneer S, Rusanov Vet al. Bronchial artery embolization for massive hemoptysis: Long-term follow-up. Asian Cardiovasc Thorac Ann. 2015;23(1):55-60.
Referanslar
Abdulmalak C, Cottenet J, Beltramo et al. Haemoptysis in adults: a 5-year study using the French nationwide hospital administrative database. European Respiratory Journal. 2015;46(2):503-11.
Ittrich H, Bockhorn M, Klose H. The Diagnosis and Treatment of Hemoptysis. Dtsch Arztebl Int. 2017;114(21):371-81.
Kathuria H, Hollingsworth HM, Vilvendhan R et al. Management of life-threatening hemoptysis. J Intensive Care. 2020;8(1):23.
Davidson K, Shojaee S. Managing Massive Hemoptysis. Chest. 2020;157(1):77-88.
Prey B, Francis A, Williams J, et al. Evaluation and Treatment of Massive Hemoptysis. Surgical Clinics of North America. 2022;102(3):465–81.
Ravetta P, Bruyneel M, Vouche M. New insights on Bronchial Artery Embolization (BAE) for hemoptysis: a systematic review. BMC Pulm Med. 2025;25(1):541.
Kaufman CS, Kwan SW. Bronchial Artery Embolization. Semin Intervent Radiol. 2022;39(03):210-7.
Radchenko C, Alraiyes AH, Shojaee S. A systematic approach to the management of massive hemoptysis. J Thorac Dis. 2017;9(S10):S1069-86.
Kettenbach J, Ittrich H, Gaubert JY et al. CIRSE Standards of Practice on Bronchial Artery Embolisation. Cardiovasc Intervent Radiol. 2022;45(6):721-32.
Chun JY, Morgan R, Belli AM. Radiological Management of Hemoptysis: A Comprehensive Review of Diagnostic Imaging and Bronchial Arterial Embolization. Cardiovasc Intervent Radiol. 2010;33(2):240-50.
McDONALD DM. Angiogenesis and Remodeling of Airway Vasculature in Chronic Inflammation. Am J Respir Crit Care Med. 2001;164:39-45.
Yoon W, Kim JK, Kim YH et al. Bronchial and Nonbronchial Systemic Artery Embolization for Life-threatening Hemoptysis: A Comprehensive Review. RadioGraphics. 2002;22(6):1395-409.
CAULDWELL EW, SIEKERT RG. The bronchial arteries; an anatomic study of 150 human cadavers. Surg Gynecol Obstet. 1948;86(4):395-412.
Guan JJ. Bronchial Artery Embolization. In: Essential Interventional Radiology Review. Cham: Springer International Publishing; 2022;733–45.
Panda A, Bhalla AS, Goyal A. Bronchial artery embolization in hemoptysis: a systematic review. Diagnostic and Interventional Radiology. 2017;23(4):307-17.
Guzelbey T, Arslan MF, Cingoz M et al. Efficacy and safety of particle embolization in bronchial arteries of hemoptysis patients with shunts. Clin Radiol. 2024;79(9):704-10.
Hwang JH, Kim JH, Park S et al. Feasibility and outcomes of bronchial artery embolization in patients with non-massive hemoptysis. Respir Res. 2021;22(1):221.
García Jurado PB, Pérez Montilla ME, Lombardo Galera MS et al. Embolización de arterias bronquiales y arterias sistémicas no bronquiales con n-butil-cianoacrilato en pacientes con hemoptisis: un estudio monocéntrico y retrospectivo. Radiologia. 2023;65(2):99-105.
Woo S, Yoon CJ, Chung JW et al. Bronchial Artery Embolization to Control Hemoptysis: Comparison of N -Butyl-2-Cyanoacrylate and Polyvinyl Alcohol Particles. Radiology. 2013;269(2):594-602.
Ryuge M, Hara M, Hiroe T et al. Mechanisms of recurrent haemoptysis after super-selective bronchial artery coil embolisation: a single-centre retrospective observational study. Eur Radiol. 2019;29(2):707-15.
Bhalla A, Kandasamy D, Veedu P et al. A Retrospective Analysis of 334 Cases of Hemoptysis Treated by Bronchial Artery Embolization. Oman Med J. 2015;30(2):119-28.
Marcelin C, Soussan J, Desmots F et al. Outcomes of Pulmonary Artery Embolization and Stent Graft Placement for the Treatment of Hemoptysis Caused by Lung Tumors. Journal of Vascular and Interventional Radiology. 2018;29(7):975-80.
Ostrowski P, Bonczar M, Glądys K, et al. The complex anatomy of the bronchial arteries: a meta-analysis with potential implications for thoracic surgery and hemoptysis treatment. Sci Rep. 2024;14(1):30942.
van den Heuvel MM, Els Z, Koegelenberg CF, Naidu KM et al. Risk factors for recurrence of haemoptysis following bronchial artery embolisation for life-threatening haemoptysis. Int J Tuberc Lung Dis. 2007;11(8):909-14.
Ishikawa H, Ohbe H, Omachi N et al. Spinal Cord Infarction after Bronchial Artery Embolization for Hemoptysis: A Nationwide Observational Study in Japan. Radiology. 2021;298(3):673-9.
Lee HN, Park HS, Hyun D et al. Combined therapy with bronchial artery embolization and tranexamic acid for hemoptysis. Acta radiol. 2021;62(5):610-8.
Fruchter O, Schneer S, Rusanov Vet al. Bronchial artery embolization for massive hemoptysis: Long-term follow-up. Asian Cardiovasc Thorac Ann. 2015;23(1):55-60.
