Objective: To study the signs of subclavian artery angiography for hemoptysis due to pulmonary tuberculosis and to evaluate its clinical use in artery embolization.
Methods: Thirty-nine patients with hemoptysis due to pulmonary tuberculosis underwent subclavian artery angiography after artery embolization performed in the hemorrhagic branches of descending aorta. Of the 39 cases, 25 had severe pulmonary fibrosis or were complicated with cavity formation, aspergilloma, pleural thickening and postoperative thorax. The signs of subclavian artery angiography were divided into three categories: (-), normal; (+), the branches of subclavian artery and axillary artery chaotic and hyperplasia; (+ +), the branches of subclavian artery and axillary artery appeared tortuosity, dilatation, aneurysm and shunt with pulmonary circulation. Signs of bleeding was designated (+) and (+ +), with (+ +) indicating strongly positive. The signs of subclavian artery angiography were studied and statistically analyzed. Artery embolization was performed in some of the patients, among whom 15 were analyzed for long-term clinical curative effect.
Results: Signs of positive bleeding was found in 32/39 of the cases, and strongly positive bleeding in 17/39 of the cases. Positive bleeding arteries accounted for 39/58 of the branches, including 24/58 (+ +) and 15/58 (+). Angiography demonstrated that the internal mammary artery, lateral thoracic artery and subscapular artery were the main hemorrhagic arteries. Patients with severe pulmonary fibrosis or complicated with cavity, aspergilloma, pleural thickening and postoperative thorax showed higher rate of positive and strongly positive bleeding. Artery embolization was performed in 15 cases: cure was achieved in 6, effective in 7 and failure in 2 cases. Of the 15 cases, 8 had been ineffective after embolization of the hemorrhagic branches of descending aorta alone.
Conclusions: Our results suggest that corresponding subclavian artery angiography should be performed after the hemorrhagic branches of descending aorta artery have been embolized for hemoptysis due to pulmonary tuberculosis, especially in cases with failed embolization, or complicated with severe pulmonary fibrosis, cavity formation, aspergilloma, pleural thickening, or postoperative thorax. The hemorrhagic arteries shown by subclavian artery angiography must be embolized.