Transcatheter arterial embolization for hemoptysis in children with bronchopulmonary artery fistulas: a single-center retrospective analysis

Objective To evaluate the safety and efficacy of transcatheter interventional embolization for hemoptysis secondary to bronchopulmonary artery fistula (BPAF) in pediatric patients. Methods A retrospective review was conducted on the clinical profiles and digital subtraction angiography (DSA) characteristics of 17 pediatric patients with BPAF-related hemoptysis. Clinical outcomes and follow-up data were analyzed. Results The cohort comprised 11 boys and 6 girls, aged 7 months to 14 years. DSA demonstrated varying degrees of bronchopulmonary shunts. All patients successfully underwent super-selective embolization of the target vessels via a microcatheter. During hospitalization, hemoptysis was immediately resolved in 16 patients (94. 1%), while Patient No. 17 experienced persistent bleeding post-intervention and required immediate surgical treatment. During the long-term post-discharge follow-up, three patients experienced recurrence: Patient No. 12 developed recurrent hemoptysis at 2 years post-procedure, which was managed with a second and a subsequent third embolization due to another recurrence 3 months later, achieving long-term remission thereafter; Patient No. 15 experienced recurrence 1 year post-procedure and remained symptom-free after a second embolization; Patient No. 14 recurred 2 months post-procedure, and due to the inability of the microcatheter to reach the target vessel during the second angiography, the patient was successfully treated with surgery. Conclusion Transcatheter interventional therapy is a safe and effective approach for managing BPAF-related hemoptysis in pediatric patients. For fistulas with high-volume shunts, positioning the microcatheter as close to the fistula orifice as possible for embolization may optimize technical and clinical success. Considering the relatively small sample size, the present results should be interpreted with caution and verified by larger follow-up studies.