Systemic-Pulmonary Artery Fistulas and Noncancer-related Hemoptysis Recurrence After Bronchial Artery Embolization: A Retrospective Study

Objectives To investigate the clinical and angiographic characteristics of systemic artery to pulmonary artery fistulas (SA-PAFs) in patients with noncancer-related hemoptysis undergoing bronchial artery embolization (BAE), and to evaluate their association with procedural outcomes and risk of hemoptysis recurrence. Methods This retrospective study included patients with noncancer-related hemoptysis who underwent BAE for noncancer-related hemoptysis between January 2020 and December 2024 at Xiangyang Central Hospital, Hubei University of Arts and Science. Patients were categorized into three groups based on SA-PAF status: non-SA-PAF, with mild SA-PAF, and with massive SA-PAF. Results A total of 276 patients with noncancer-related hemoptysis were included in the analysis. SA-PAFs were identified in 216 patients (78.3%), including 134 (48.6%) with mild SA-PAF and 82 (29.7%) with massive SA-PAF. Compared with the non-SA-PAF group, patients with massive SA-PAFs had a significantly higher number of culprit arteries, and a greater proportion of ectopic bronchial arteries (BAs) and non-bronchial systemic arteries (NBSAs) as arterial sources. The overall clinical success rate of BAE was 98.2% (271/276); however, complete cessation was less frequent in the massive SA-PAF group (79.3%) compared to the mild (91.0%) and non-SA-PAF (95.0%) groups. Hemoptysis recurrence occurred in 54 patients (19.6%), with a significantly higher recurrence rate in the massive SA-PAF group (32.9%) compared to the mild SA-PAF (15.0%) and non-SA-PAF groups (13.6%). Multivariable Cox regression identified the presence of ectopic BAs as an independent predictor of hemoptysis recurrence (HR: 2.996, 95% CI: 1.521–5.901, p = 0.002). Conclusion SA-PAFs were frequently observed in noncancer-related hemoptysis patients treated with BAE. Massive SA-PAFs were associated with greater vascular complexity, a lower rate of complete hemostasis after BAE, and an increased risk of recurrence.