Predictors of Recurrence Following Bronchial Artery Embolisation (BAE) for Haemoptysis: A Systematic Review and Evidence Synthesis Analyses Using SWiM Guidelines.
Diya Sethi, Tejas Ramnath Iyer, Sinan Abu-Al-Timen
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In 30 seconds
This systematic review synthesised cohort studies of haemoptysis recurrence after bronchial artery embolisation (BAE), using a Synthesis Without Meta-analysis approach because of clinical heterogeneity and mixed embolic agents. Sixty-five studies involving 12,143 patients were included. Multivariable evidence identified systemic-pulmonary shunts, non-bronchial systemic collaterals, pleural thickening, bronchiectasis, aspergillosis, prior haemoptysis, positive sputum culture, and abnormal platelet indices as independent predictors of recurrence. No embolic agent showed clear superiority. The authors identify chronic parenchymal destruction and systemic-pulmonary shunts as key factors in recurrence.
Key findings
- Across 65 studies involving 12,143 patients, systemic-pulmonary shunts and non-bronchial systemic collaterals were independent predictors of recurrence.
- Pleural thickening, bronchiectasis, aspergillosis, prior haemoptysis, positive sputum culture, and abnormal platelet indices also predicted recurrence independently.
- No specific embolic agent demonstrated clear superiority in preventing recurrent haemoptysis.
- Active tuberculosis, pulmonary malignancy, post-tuberculous sequelae, high-volume haemoptysis, cystic fibrosis, and concurrent anticoagulant use were neutral predictors.
Why it matters
Recurrence after BAE appears to relate importantly to underlying parenchymal disease and systemic-pulmonary vascular connections, rather than to presentation characteristics or a particular embolic agent. Recognising these factors may help frame recurrence risk and focus attention on angiographic assessment and management of underlying disease, while the evidence remains synthesised from heterogeneous cohort studies.
What to keep in mind
Clinical heterogeneity and mixing of embolic agents within cohorts precluded meta-analysis; findings were synthesised using vote-counting rather than pooled effect estimates.