Factors affecting recurrence of hemoptysis following bronchial artery embolization in patients with tuberculosis and its sequelae

To assess the factors causing recurrence following bronchial artery embolization (BAE) in patients with hemoptysis due to tuberculosis (TB) and its sequelae From March 2013 to March 2015, 43 patients with microbiologically proven TB underwent BAE for hemoptysis and were evaluated for response to treatment with follow-up of 6 months. 36 males and 7 females were studied with mean age of 49.5 years. Embolization was done with PVA particles (300 –500 microns Cook Bloomington Indiana) using coaxial microcatheter system (Progreat, Teurmo, Somerset, NJ). 100% immediate success was achieved. 5 patients (11.6%) had recurrent hemoptysis within the first month, 8 patients (18.6%) within 3 months and 7 patients (16.7%) within 6 months. 12 out of 20 patients (60%) with recurrence required repeat embolization among whom 5 patients presented with massive hemoptysis while 7 patients had moderate symptoms. Multi Drug Resistant (MDR) TB was found in 9 patients (45%) with recurrence among whom 4 patients were taken up for repeat procedure. Bilateral lung parenchymal disease was reported in 12 patients (60%) with recurrence among whom 8 patients required repeat procedure. Aspergilloma was found in 4 patients (20%) with recurrence all of whom underwent a repeat embolization while cavitary lesion without fungal ball was found in 3 patients (15%) and parenchymal fibrosis and bronchiectasis in 5 and 2 patients each (25% and 10%) among whom only 3 patients required re-embolization. Co-existent pulmonary pathology like interstitial lung disease (ILD) was seen in 4 patients (20%) all of whom required repeat procedure. Among the patients with recurrence who had a repeat angiography, 8 patients (66.6%) had bronchial as well as non-bronchial vessels showing abnormal blush, hypertrophy and tortuosity. Patients with MDR TB (p=0.54), presence of aspergilloma (p=0.57) and associated ILD (p=0.67) were found to be important factors affecting recurrence Among patients with TB, higher recurrence rates should be explained to patients with MDR TB, aspergilloma or associated ILD and non-bronchial vessels should be meticulously searched for pathology