Clinical and angiographic predictors of recurrent hemoptysis following bronchial artery embolization: The impact of non-bronchial systemic arteries and pulmonary–bronchial anastomoses

Background Bronchial artery embolization (BAE) is the first-line treatment for hemoptysis with high success rates. However, recurrent hemoptysis remains a significant clinical problem. The role of non-bronchial systemic arteries (NBSAs) and pulmonary–bronchial arterial anastomoses in predicting recurrence remains incompletely understood. Purpose To evaluate clinical and angiographic predictors of recurrent hemoptysis after BAE. Material and Methods This retrospective single-center study included 148 patients who underwent technically and clinically successful BAE for hemoptysis between 2022 and 2024. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of recurrence. ROC analysis was used to evaluate the predictive value of hemoptysis volume. Results Recurrent hemoptysis occurred in 42 (28.4%) patients. Multivariate analysis identified NBSAs (odds ratio (OR) = 10.11, 95% confidence interval (CI) = 1.50–68.02; P = 0.017), pulmonary–bronchial arterial anastomoses (OR = 4.43, 95% CI = 1.53–12.85; P = 0.006), and tuberculosis etiology (OR = 6.81, 95% CI = 2.20–21.05; P < 0.001) as independent predictors. Hemoptysis volume showed limited predictive performance (AUC = 0.591; P = 0.039). Conclusion NBSAs and pulmonary–bronchial anastomoses are strong independent predictors of recurrent hemoptysis after BAE. Notably, this association persisted even when NBSAs were successfully embolized, suggesting a biological rather than technical basis for recurrence. Patients with complex vascular anatomy and tuberculosis require closer post-procedural surveillance and may benefit from more intensive follow-up strategies after embolization.