Presence of bronchopulmonary shunting is an independent risk factor for recurrence of hemoptysis following bronchial artery embolization in younger patients with bronchiectasis: a long-term outcome

To explore the potential risk factors of recurrence after bronchial artery embolization (BAE) treatment in patients with bronchiectasis. All patients underlying bronchiectasis undergoing BAE for treatment of hemoptysis from November 2011 to May 2018 in our center were analyzed. The basic characteristics, imageological and angiographic features, as well as procedural details were retrospectively reviewed by searching the medical records. Repeated embolization, hemoptysis free survival rates and duration as well as the cause of death were assessed by follow-up.A total of 126 BAE procedures were attempted in 118 enrolled patients. Amongst the 231 culprit vessels embolized completely, the presence of non-bronchial systemic arteries (NBSA) and bronchopulmonary shunting (BPS) were 12.1% and 22.0% respectively. A total of 26 (22.0%) patients occurred recurrent hemoptysis. Eleven (42.3%) patients followed by repeated BAE. The hemoptysis-free of survival time after first BAE was 65 ± 3 months (range 1 to 85 months). Cox regression analysis showed that age (HR=0.958, 95% CI= 0.937 to 0.979, p<0.001) as well as the presence of BPS (HR=2.6, 95%CI 1.126 to 5.998, p=0.025) had significant association with recurrence. Patients with the presence of BPS suffered shorter hemoptysis-free survival time compared with individuals without BPS (45.7 ± 4.8 vs. 71.7 ± 3.4 months, p=0.01). BPS was a strong predictor of recurrent hemoptysis after BAE for younger patients, suggesting that those with existence of BPS at angiography may have a negative effect on long-term hemoptysis free survival time.