document: hemoptysis is one of the most common symptoms in patients with respiratory diseases , when massive , has a mortality rate of more than 50% 
   . therefore , significant or life - threatening hemoptysis calls for quick treatment to stop bleeding . in the past 
   , the control of hemoptysis had been obtained using surgical methods if conservative management failed to be effective . but 
   patients with massive hemoptysis may be associated with high morbidity and mortality using conservative or surgical management . 
   it is a safe and effective treatment , not only for massive hemoptysis , but also for chronic or recurrent hemoptysis that impairs the patient 's quality of life . 
   the first procedure for embolization therapy is a complete angiography of the pulmonary vascular tree when bleeding bronchial arteries are seen , embolization therapy is carried out . 
   this retrospective study was undertaken to determine the demographic characteristics , clinical features , results of imaging techniques , complications related to bae , and follow - up of 344 patients underwent bae . 
   this study was a retrospective analysis of 344 cases , who underwent bronchial arteriography at tianjin haihe hospital between 2006 and 2013 . 
   the patients were hospitalized due to hemoptysis , with the volume of blood ranging 502000 ml/24 h. each patient underwent standard medical management , but the hemoptysis still occurred , so they underwent bronchial arteriography at first and underwent bae when necessary . 
   there were 186 men and 158 women , with a mean age of 57 years old ( ranging 1783 years old ) . 
   two hundred and thirty - four patients had acute and massive hemoptysis , and 110 patients had chronic and recurrent hemoptysis ( recurrent rate at least 3 times in 1 year ) . 
   the data for outcome analysis were obtained from the clinical records , all of the radiological images were reviewed as possible . 
   we collected such data for analysis : clinical features ; chest computed tomography ( ct ) scan ; bronchial ateriography , bae , and results ; embolization material ; complications related to bae ; and follow - up . 
   about 317 patients ( 92.2% ) were suggestive of causes of hemoptysis , and 27 patients ( 7.8% ) showed focal hemorrhage . 
   blood lobe could be identified by chest ct scan in 105 cases ( 30.5% ) . 
   bleeding source could be localized in unilateral lung but could not be defined in an exact lobe in 90 cases ( 36.2% ) . 
   both of the lungs had unusual film but not focal hemorrhage in 149 patients ( 43.3% ) . 
   the findings of angiography suggested that few direct sign found during arteriography , most of the indirect appearances that support a site of bleeding include tortuosity , hypertrophy , hypervascularity , aneurysms , extravasation , and bronchial artery to pulmonary artery or vein shunting . in 131 
   patients ( 38.1% ) , only left - side bronchial arteries were abnormal ; in 69 patients , only right - side bronchial arteries were abnormal ; in the other 144 patients , bilateral bronchial arteries were abnormal . 
   as the statistics , 944 responsible bronchial arteries involves in according to the angiography : 275 right bronchial arteries ; 200 left bronchial arteries ; 170 combined right and left bronchial trunk ; 123 right intercostal arteries ; other 176 arteries [ figure 1 ] . 
   we analyzed the responsible arteries for tuberculosis , bronchiectasis , bronchogenic carcinomas and undefined reasons as follow [ table 1 ] . 
   a spinal artery was identified in three patients , one spinal artery originated from the left bronchial artery , one from the right intercostal artery , and one from the right subclavian artery . 
   the numbers of responsible arteries for different diseases despite of which kind of causations , the main responsible arteries were right bronchial artery , left bronchial artery and combined right and left bronchial trunk ; more right intercostal arteries were involved than left . 
   bronchial artery embolization was performed in 336 of 344 patients ( 97.7% ) , artery spasm and closure occurred in six patients , arterial subintimal dissection occurred in one patient , and the responsible vessel could nt be super - selective in one patient because of combining with the spinal artery . 
   overall , there were 1530 embolization coils for the 336 patients with a total of 920 arteries embolized ( including bronchial and nonbronchial systemic arteries ) . according to the chest ct scanning and bronchial arteriography , we concluded the etiologies of the hemoptysis in 344 cases : tuberculosis in 190 patients ( 55.2% ) , bronchiectasis in 99 patients ( 28.8% ) , malignancy in 20 patients ( 5.8% ) , undefined in 18 patients ( 5.2% ) , pneumonia in six patients ( 1.8% ) , deformity of bronchial artery in six patients ( 1.8% ) , bronchial artery aneurysm in one patients ( 0.2% ) , other pulmonary disease in four patients ( 1.2% ) . 
   bronchial artery embolization was successful in controlling hemoptysis immediately in 330 of 344 patients ( 96% ) . 
   61 patients ( 17.7% ) had recurrent hemoptysis within 1 month after undergoing bae , only three of them were performed a second bae , two patients had rebleeding in the previous site , one was found new bleeding area . 
   three of these patients died of massive hemoptysis in 1 month after undergoing embolization ( two patients with bronchogenic carcinoma and one with tuberculosis ) , one patient with severe chronic obstructive pulmonary disease died of hypercapnia in 3 days after undergoing embolization . 
   the two patients in whom an embolization procedure could not be performed ( one because of spinal artery combined with the hemorrhage vessel and one was under subintimal dissection ) , taken medical treatment for 1 week , the hemoptysis were gradually controlled . 
   each patient performed bae had a repeated chest ct scanning after 1 month , which showed that there was no coil dropping or shifting . 
   seventy four patients ( 21.5% ) had recurrent hemoptysis over 1 month after undergoing bae . 
   forty - four patients were performed a repeated embolization , all of the bronchial arteriograms bronchial arteriograms showed there was no dropping of the coil , in 17 patients developed recanalization of the previously embilzed vessels , the remaining 27 patients developed new blood vessels responsible for hemorrhage . 
   one hundred and seven patients ( 31.1% ) had a fever ( < 38.5c ) after bae . 
   chest pain postprocedure occurred in 65 patients ( 18.9% ) , back pain in 51 patients ( 14.8% ) , shoulder pain postprocedure in 29 patients ( 8.4% ) , and transient dysphagia or lower limb numbness in three patients ( 0.9% ) . 
   all of the patients had been followed up over 1 month after bae except the four patients had been died within 1 month . 
   two hundred and forty - eight patients had a telephone call follow - up recently ( follow - up periods ranging from 6 months to 8 years ) . 
   it revealed that 28 patients had been dead , six of them died of massive hemorrhage , seven died of deterioration of lung disease but not bleeding , the remainder died of other diseases or accident . 
   four patients died within 1 year after due to advanced lung cancer ( one had a massive bleeding out of controlling ) , 24 patients died during 24 years after bae . 
   twenty - one patients have recurrent hemoptysis after repeated bae , the volume of bleeding is < 5 ml / d . 
   one hundred and ninety - nine patients had follow - up periods ranging from 6 months to 8 years without evidence of recurrent hemoptysis . 
   about 317 patients ( 92.2% ) were suggestive of causes of hemoptysis , and 27 patients ( 7.8% ) showed focal hemorrhage . 
   blood lobe could be identified by chest ct scan in 105 cases ( 30.5% ) . 
   bleeding source could be localized in unilateral lung but could not be defined in an exact lobe in 90 cases ( 36.2% ) . 
   both of the lungs had unusual film but not focal hemorrhage in 149 patients ( 43.3% ) . 
   the findings of angiography suggested that few direct sign found during arteriography , most of the indirect appearances that support a site of bleeding include tortuosity , hypertrophy , hypervascularity , aneurysms , extravasation , and bronchial artery to pulmonary artery or vein shunting . in 131 
   patients ( 38.1% ) , only left - side bronchial arteries were abnormal ; in 69 patients , only right - side bronchial arteries were abnormal ; in the other 144 patients , bilateral bronchial arteries were abnormal . 
   as the statistics , 944 responsible bronchial arteries involves in according to the angiography : 275 right bronchial arteries ; 200 left bronchial arteries ; 170 combined right and left bronchial trunk ; 123 right intercostal arteries ; other 176 arteries [ figure 1 ] . 
   we analyzed the responsible arteries for tuberculosis , bronchiectasis , bronchogenic carcinomas and undefined reasons as follow [ table 1 ] . 
   a spinal artery was identified in three patients , one spinal artery originated from the left bronchial artery , one from the right intercostal artery , and one from the right subclavian artery . 
   the numbers of responsible arteries for different diseases despite of which kind of causations , the main responsible arteries were right bronchial artery , left bronchial artery and combined right and left bronchial trunk ; more right intercostal arteries were involved than left . 
   bronchial artery embolization was performed in 336 of 344 patients ( 97.7% ) , artery spasm and closure occurred in six patients , arterial subintimal dissection occurred in one patient , and the responsible vessel could nt be super - selective in one patient because of combining with the spinal artery . 
   overall , there were 1530 embolization coils for the 336 patients with a total of 920 arteries embolized ( including bronchial and nonbronchial systemic arteries ) . 
   according to the chest ct scanning and bronchial arteriography , we concluded the etiologies of the hemoptysis in 344 cases : tuberculosis in 190 patients ( 55.2% ) , bronchiectasis in 99 patients ( 28.8% ) , malignancy in 20 patients ( 5.8% ) , undefined in 18 patients ( 5.2% ) , pneumonia in six patients ( 1.8% ) , deformity of bronchial artery in six patients ( 1.8% ) , bronchial artery aneurysm in one patients ( 0.2% ) , other pulmonary disease in four patients ( 1.2% ) . 
   bronchial artery embolization was successful in controlling hemoptysis immediately in 330 of 344 patients ( 96% ) . 
   61 patients ( 17.7% ) had recurrent hemoptysis within 1 month after undergoing bae , only three of them were performed a second bae , two patients had rebleeding in the previous site , one was found new bleeding area . 
   three of these patients died of massive hemoptysis in 1 month after undergoing embolization ( two patients with bronchogenic carcinoma and one with tuberculosis ) , one patient with severe chronic obstructive pulmonary disease died of hypercapnia in 3 days after undergoing embolization . 
   the two patients in whom an embolization procedure could not be performed ( one because of spinal artery combined with the hemorrhage vessel and one was under subintimal dissection ) , taken medical treatment for 1 week , the hemoptysis were gradually controlled . 
   each patient performed bae had a repeated chest ct scanning after 1 month , which showed that there was no coil dropping or shifting . 
   seventy four patients ( 21.5% ) had recurrent hemoptysis over 1 month after undergoing bae . 
   forty - four patients were performed a repeated embolization , all of the bronchial arteriograms bronchial arteriograms showed there was no dropping of the coil , in 17 patients developed recanalization of the previously embilzed vessels , the remaining 27 patients developed new blood vessels responsible for hemorrhage . 
   one hundred and seven patients ( 31.1% ) had a fever ( < 38.5c ) after bae . 
   chest pain postprocedure occurred in 65 patients ( 18.9% ) , back pain in 51 patients ( 14.8% ) , shoulder pain postprocedure in 29 patients ( 8.4% ) , and transient dysphagia or lower limb numbness in three patients ( 0.9% ) . 
   all of the patients had been followed up over 1 month after bae except the four patients had been died within 1 month . 
   two hundred and forty - eight patients had a telephone call follow - up recently ( follow - up periods ranging from 6 months to 8 years ) . 
   it revealed that 28 patients had been dead , six of them died of massive hemorrhage , seven died of deterioration of lung disease but not bleeding , the remainder died of other diseases or accident . 
   four patients died within 1 year after due to advanced lung cancer ( one had a massive bleeding out of controlling ) , 24 patients died during 24 years after bae . 
   twenty - one patients have recurrent hemoptysis after repeated bae , the volume of bleeding is < 5 ml / d . 
   one hundred and ninety - nine patients had follow - up periods ranging from 6 months to 8 years without evidence of recurrent hemoptysis . 
   earlier , besides medical treatment , surgery was the fast and best method to control the bleeding . 
   but it required patients many preparations , such as chest ct , pulmonary function , even bronchoscopy to evaluate the patient physical condition and determine the range of surgery . 
   some preparations were impossible for the patients in emergency conditions , the impairment of surgery was so great for a lot of people that gravely lowered the quality of life . 
   bae is a well - established procedure used to control massive hemoptysis since it first performed in 1974 . 
   subsequently , bae was widely used , because non - operable patients could be treated and other patients could be stabilized prior to surgery . in clinical , 
   about 1 hour is needed to prepare before bae , and the physical requirements of patient are lower than for surgery . 
   the technology is mostly described the outcomes in control of hemoptysis due to varies causations . in some conditions , interventional embolization can be used before surgery . in our study , 
   of the 344 cases , an immediate control of bleeding was achieved with embolization in 330 patients ( 96% ) , similar to the immediate success rate was reported 7598% earlier . 
   recurrent bleeding despite apparently adequate embolotherapy remains a considerable problem , some reported with bleeding occurring in 942% of patients after embolization . in our series , rebleeding occurred within 30 days in 61 of 344 patients ( 17.7% ) . 
   a second embolization procedure was performed in three patients , two patients were found rebleeding in the previous points , and one was found new bleeding arteries . 
   overall the patients , 54 of whom rebleeding over 1 month in the follow - up , 44 of whom were performed a second bronchial arteriography . in 27 patients , 
   an additional bronchial or nonbronchial collateral artery was embolized resulting in the successful control of hemoptysis , 17 patients developed recanalization of the previously embilzed vessels and had been embolizied again . in the recurrent hemoptysis patients , 
   the etiologies were mainly due to cancer , tuberculosis , and severe bronchietasis ( at least two lobes were suffered ) . 
   the disease development contributed to the rebleeding . in our series , a patient with cancer was performed in bae for three times , and a patient with tuberculosis was performed for five times , both of whom were not suitable for surgery . 
   so it has shown that bae is an effective procedure with which to definitively treat some patients with hemoptysis and can be repeatedly utilized . 
   as we know , the source of massive hemoptysis in 90% of cases due to the brochial circulation , as well as the remaining 10% divided equally between the pulmonary circulation ( 5% ) and other systemic arterial supply to the lungs . 
   it is well - documented that the anatomy of bronchial arteries is variable form person to person , typically origin arises from the descending aorta between the levels of the t5 and t6 vertebrae . 
   four classic patterns of origin were described : type i ( 40% ) : two on the left and one on the right , presenting as an intercostobronchial trunk ( icbt ) ; type ii ( 21% ) : one on the left and one icbt on the right ; type iii ( 20% ) : two on the left and one on the right ( one icbt and one bronchial artery ) ; type iv ( 9.7% ) : one on the left and two on the right ( one icbt and one bronchial artery ) . according to the statistics , 
   the main responsible vessels for bleeding are right bronchial arteries , left bronchial arteries , combined right and left bronchial trunk , right intercostal arteries . in different etiologies , the rate of abnormal arteries is coincidence with the result . 
   the bronchial arteriography showed that more right intercostal arteries combining with bronchial artery than left . 
   the distribution and frequency of embolization of the arteries were agreed with kwon et al . usually 
   , a spinal artery can originate from a bronchial artery in up to 5% of patients , with right side being more common than the left side . as our observation , 
   a spinal artery was identified in three of our patients , with two occurring on the right side and one occurring on the left side . 
   our result showed that tuberculosis ( 55.2% ) , bronchiectasis ( 28.8% ) , malignancy ( 5.8% ) , undefined ( 5.2% ) , pneumonia ( 1.8% ) , deformity of bronchial artery ( 1.8% ) , bronchial artery aneurysm ( 0.2% ) , other pulmonary disease ( 1.2% ) . 
   , the etiologies of hemoptysis included tuberculosis ( 34% ) , bronchiectasis ( 26% ) , aspergilloma ( 18% ) , neumoconiosis in coal miners ( 13% ) , and bronchogenic carcinoma ( 3% ) . 
   knott - craig et al . retrospectively studied 120 patients with hemoptysis and found that the right lung was the source in 62% and the left lung in 38% , with the right upper lobe being the area that was most commonly affected . 
   our results were that the right lung was the source of bleeding in 131 patients ( 38.1% ) , the left lung was the source in 69 patients ( 20.0% ) , and both lungs were the source in 144 patients ( 41.8% ) . 
   the common complications of bae included subintimal dissection , arterial perforation by a guidewire , and reflux of embolic material into the artery without adverse sequelaed during the procedure , and fever , chest pain , dyspnea , transient dysphagia , groin hematoma , even headache or blindness etc . 
   several patients developed transverse myelitis as a result of inadvertent embolization of the spinal arteries . during the procedure of bae , when a spinal artery was founding , 
   but in contrast , mal et al . observed the brown - sequard 's syndrome , following three episodes of spinal cord complications , which regressed after 4 months without sequelae ; paraparesis with spontaneous regression after 2 weeks ; and complete paraplegia without regression . 
   if a spinal artery arises from a bronchial artery , we will only embolize the bronchial artery if we can achieve a stable distal position well beyond the spinal artery origin . 
   our patients showed transistent complications such as fever , chest pain , shoulder pain , groin hematoma , all the symptoms were disappeared in 48 hours , and fewer of our patients experienced any neurologic sequelae . 
   observed the outcome of bae : the hemoptysis control rate was 93.1% at the end of 2 weeks , 85.7% at the end of 1 month , 79.5% at 90 days , 63.2% at 180 days , 51% at 1 year and 38.7% at the end of 2 years . 
   the follow - up of our patients revealed that 28 patients had died , and six from massive hemorrhage and the remainder as a result of their disease process . 
   twenty - one patients have recurrent hemoptysis after repeated bae , the volume of bleeding is < 5 ml / d , taking medicine can control the bleeding . 
   one patient suffered recurrent hemoptysis wanted to take a surgical management , but the diffuse disease in lung limited the management . 
   there was no follow - up information available on 92 patients , because they did not return after treatment and the telephone numbers were null . 
   the remaining 199 patients had follow - up periods ranging from 6 months to 8 years without evidence of recurrent hemoptysis . in summary 
   , hemoptysis represents a significant clinical entity with high morbidity and potential mortality . medical management ( in terms of resuscitation and bronchoscopic interventions ) and surgery 
   bae procedures represent the first - line treatment for hemoptysis arising from bronchial arterial source . in our study 
   , it was very useful in obtaining immediate bleeding control which was slightly better than that in other report . 
   the technique was a relatively safe and effective method for control the hemoptysis , importantly , it can be used repeatedly . in our study , 
   more than 50% patients had massive hemoptysis , about 70% patients ca nt be identified bleeding point by chest ct , 41% patients hemorrhage source from two lungs according the bronchial arteriography . 
   although the long - term outcome in some patients is not good , bae may be the only life - saving treatment option in patients who are poor surgical candidates .
summary: background : hemoptysis is a significant clinical entity with high morbidity and potential mortality . 
   both medical management ( in terms of resuscitation and bronchoscopic interventions ) and surgery have severe limitations in these patients population . 
   bronchial artery embolization ( bae ) represents the first - line treatment for hemoptysis . 
   this article discusses clinical analysis , embolization approach , outcomes and complications of bae for the treatment of hemoptysis.methods:a retrospective analysis of 344 cases , who underwent bronchial arteriography at tianjin haihe hospital between 2006 and 2013 . 
   several aspects of outcome were analyzed : demographics , clinical presentation , radiographic studies , results , complications and follow - up of bae.results:three hundred and forty - four consecutive patients underwent bronchial arteriography , 336 of 344 patients ( 97.7% ) performed bae ; there were 1530 coils for 920 arteries embolized ; the main responsible sources for bleeding were right bronchial artery ( 29.7% ) , left bronchial artery ( 21.6% ) , combined right and left bronchial trunk ( 18.4% ) , right intercostal arteries ( 13.3% ) ; 61 patients ( 17.7% ) had recurrent hemoptysis within 1 month after undergoing bae , 74 patients ( 21.5% ) had recurrent hemoptysis over 1 month after undergoing bae ; the common complications of bae included subintimal dissection , arterial perforation by a guide wire , fever , chest pain , dyspnea , etc . 
   the follow - up was completed in 248 patients , 28 patients had been dead , 21 patients still bleed , 92 patients had lost to follow-up.conclusions:the technique of bae is a relatively safe and effective method for controlling hemoptysis . 
   the complications of bae are rare . 
   although the long - term outcome in some patients is not good , bae may be the only life - saving treatment option in patients who are poor surgical candidates .