الفهرس 
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Abstract
Life-threatening hemoptysis is one of the most challenging conditions encountered in critical care and requires a thorough and timely investigation. Despite advances in medical and intensive care unit management, massive hemoptysis re-mains a serious threat. Conservative management of massive hemoptysis carries a mortality rate of 50%–100%. The cause of death is usually asphyxiation, not exsanguinations. The reported mortality rates for surgery performed for massive hemoptysis range from 7.1% to 18.2%. However, the mortality rate increases significantly, up to about 40%, when the surgery is undertaken as an emergency procedure.
Massive hemoptysis constitutes a significant and often life-threatening respiratory emergency. Bronchial and nonbronchial systemic artery embolization is a safe and effective nonsurgical treatment for patients with massive hemoptysis.
Bronchial artery embolization (BAE) has become an established procedure in the management of massive and recurrent hemoptysis; its use was first reported in 1973 by Remy et al. The efficacy, safety, and utility of BAE in controlling massive hemoptysis have been well documented in many subsequent reports. Because of poor pulmonary reserve and other medical co-morbid conditions, most patients with massive hemoptysis are not surgical candidates. However, surgery remains the procedure of choice in the treatment of massive hemoptysis caused by specific conditions, such as hydatid cyst, thoracic vascular injury, bronchial adenoma and aspergilloma that is resistant to other. Even in surgical candidates, BAE is effective in preparing the patient for elective rather than high-risk emergency surgery.
Angiographic findings in massive hemoptysis include hypertrophic and tortuous bronchial arteries, neovascularity, hypervascularity, shunting into the pulmonary artery or vein, extravasation of contrast medium, and bronchial artery aneurysm, Although extravasation of contrast medium is considered a specific sign of bronchial bleeding, this finding is rarely seen, and its reported prevalence ranges from 3.6% to 10.7%. Thus, the determination of which arteries are to be embolized should be based on a combination of CT, bronchoscopic, and angiographic findings with clinical correlation. All angiograms, including intercostal arteriograms, must be carefully scrutinized for opacification of spinal arteries to avoid inadvertent embolization.
Conclusions: Bronchial artery embolization is a safe and effective nonsurgical treatment for patients with massive hemoptysis. Knowledge of bronchial artery anatomy, together with an understanding of the pathophysiologic features of massive hemoptysis, are essential for performing BAE.
Most complications related to the procedure are minor. It is believe the use of microcatheters for superselective catheterization and embolization may minimize serious complications related to spinal cord injury. With appropriate technique it is a safe and well-tolerated procedure with a better outcome than medical treatment, surgical intervention, or bronchoscopic techniques alone.