Pulmonary artery involvement contributes to the recurrence of hemoptysis after bronchial artery embolization in patients with chronic pulmonary aspergillosis.

Background: Patients with chronic pulmonary aspergillosis (CPA) frequently face severe clinical challenges due to hemoptysis. Although bronchial artery embolization (BAE) is effective in controlling acute hemoptysis, the long-term recurrence rate remains high (up to 50%). Current research has mostly focused on culprit vessels originating from the systemic circulation, whereas the role of the pulmonary artery system (e.g., pulmonary artery pseudoaneurysm) in hemoptysis recurrence remains unclear. This study aimed to analyze the clinical characteristics of patients with CPA complicated by hemoptysis who underwent BAE, and to identify independent risk factors for hemoptysis recurrence. Methods: In this single-center retrospective observational study, 58 CPA patients who underwent BAE for hemoptysis between January 2021 and January 2024 were enrolled. Based on hemoptysis recurrence within one-year post-procedure, patients were divided into a recurrence group (n=23) and a non-recurrence group (n=29). Baseline characteristics, imaging findings, and details of interventional procedures were collected. Univariate and multivariate Cox regression analyses were performed to identify independent risk factors for hemoptysis recurrence, and Kaplan-Meier survival curves were plotted. Results: Among the 58 patients, the median age was 63 years and 62.1% were male. The one-year recurrence rate was 39.7%. Univariate analysis revealed that male sex, parenchymal destruction, the presence of three or more underlying pulmonary diseases, pulmonary artery involvement, and an increased number of embolized non-bronchial systemic arteries were associated with recurrence (P<0.05). Multivariate Cox regression analysis indicated that pulmonary artery involvement was an independent risk factor for hemoptysis recurrence after BAE [hazard ratio (HR) =3.43, 95% confidence interval (CI): 1.31-9.02, P=0.01]. The proportion of patients with pulmonary artery involvement was significantly higher in the recurrence group than in the non-recurrence group (60.9% Conclusions: Pulmonary artery involvement is an important independent risk factor for hemoptysis recurrence after BAE in patients with CPA. This finding suggests that the pathological mechanism of hemoptysis in CPA involves "a dual systemic-pulmonary circulation mechanism". In clinical practice, when performing interventional therapy for CPA patients with hemoptysis, in addition to the thorough embolization of culprit systemic arteries, routine assessment and active management of pulmonary artery lesions should be considered, as this may help reduce the long-term risk of recurrence.