Risk Factors for the Recurrence of Massive Hemoptysis Treated With Bronchial Artery Embolization: A Retrospective Study

BACKGROUND: Bronchial artery embolization (BAE) is preferred for massive hemoptysis. However, the suboptimal short-term and long-term therapeutic outcomes have necessitated the initiation of this study. The aim of this study was to identify risk factors that influence the recurrence of massive hemoptysis after BAE and determine active prevention and control measures to reduce recurrence. METHODS: Between January 2019 and November 2024, a total of 162 patients with massive hemoptysis underwent BAE, of whom 47 required re-embolization due to recurrence. Baseline data of patients, technical success, clinical success, recurrence, complications, and other relevant information were collected from outpatient and inpatient medical records and subsequently analyzed. The Cox regression analysis and Forest map were employed to analyze the risk factors associated with recurrence of massive hemoptysis after BAE. RESULTS: Findings suggested that the technical success rate was (160/162) 98.76% and clinical success rate was (115/162) 70.99% during the 12-month follow-up. Mean recurrence-free time was 26 ± 3.43 days (95% CI: 19.28-32.72) among 47 patients who experienced recurrence following BAE. Multivariate Cox regression analysis showed that the risk factors for early recurrence of hemoptysis following BAE were the extent of destroyed lung (OR = 0.562 [95% CI: 0.325-0.973], p = 0.04), whether preoperative computed tomography angiography (CTA) (OR = 0.204 [95% CI: 0.083-0.499], p = 0.001), or technical factors (OR = 4.621 [95% CI: 1.936-11.028], p = 0.001), while the risk factor for late recurrence was the progression of underlying diseases (OR = 6.071 [95% CI: 1.968-18.731], p = 0.002). However, the overall risk factors for recurrent hemoptysis after BAE included the extent of destroyed lung (OR = 0.606 [95% CI: 0.404-0.91], p = 0.016), whether preoperative CTA (OR = 0.49 [95% CI: 0.266-0.905], p = 0.023), technical factors (OR = 2.176 [95% CI: 1.089-4.348], p = 0.028), and the progression of underlying diseases (OR = 1.958 [95% CI: 1.047-3.662], p = 0.035. There were no major complications related to BAE requiring immediate treatment, and only minor complications were observed. CONCLUSION: This study preliminarily concludes that the extent of destroyed lung, whether preoperative CTA, technical factors, and the progression of underlying diseases are independent risk factors associated with hemoptysis recurrence after BAE. Through comprehensive preoperative assessments, individualized embolization strategies, and proactive postoperative management of underlying diseases, the risk of recurrent hemoptysis can be significantly reduced.