Non-bronchial systemic arteries in massive hemoptysis secondary to pulmonary tuberculosis: risk factors and outcomes of embolization materials. A retrospective observational study.

OBJECTIVES: To investigate the distribution characteristics, independent risk factors of non-bronchial systemic arteries (NBSA) in patients with pulmonary tuberculosis. METHODS: A retrospective analysis was performed using clinical data of 91 patients (75 males and 16 females) with pulmonary tuberculosis complicated by massive hemoptysis who underwent bronchial artery embolization (BAE). Patients were divided into the NBSA group (65 cases) and the non-NBSA group (26 cases). The NBSA group was further divided into the polyvinyl alcohol (PVA) particle group (45 cases) and the microsphere group (20 cases) based on the embolization material used. Univariate and multivariate COX regression analyses were used to identify independent risk factors for NBSA. RESULTS: A total of 130 hemorrhagic lung lobes were involved in 91 patients (bilateral upper lobes accounting for 85.4%), with 281 responsible blood vessels, including 131 NBSAs. The main NBSAs were the posterior intercostal artery (41.98%), internal thoracic artery (35.11%), and lateral thoracic artery (9.16%). Aspergillus infection (OR = 87.909, P = 0.006) and pleural thickness ≥ 2 mm (OR = 8.532, P = 0.048) were independent risk factors for NBSA occurrence. There were no statistically significant differences in hemoptysis recurrence rate at 3 months and 1 year after surgery, median hemoptysis-free survival time, or incidence of adverse reactions between the PVA group and the microsphere group (all P > 0.05). The technical success rate of entire group was 100%, and the clinical effectiveness rate was 94.5%. CONCLUSION: Bronchial artery embolization demonstrated high technical success and clinical effectiveness in managing massive hemoptysis in pulmonary tuberculosis, with non-bronchial systemic arteries playing a significant role.