Diagnosis and Embolization of Pulmonary Esophageal Artery Hemoptysis in Lower Lobe Pulmonary Disease: Single-Center Study.

PurposeTo systematically evaluate PEA's contribution to lower lobe hemoptysis, characterize associated systemic-to-pulmonary shunts (SPS), and assess the safety/efficacy of polyvinyl alcohol (PVA) particle embolization.Materials and MethodsThis retrospective cohort study analyzed 428 patients with PEA-related hemoptysis (19% of 2296 TAE cases) treated at the First Affiliated Hospital of Guangzhou Medical University (2014-2023). Digital subtraction angiography (DSA) mapped PEA anatomy and SPS, followed by tailored PVA embolization (90-1000 μm). Outcomes included technical success, recurrence rates, and complications. Sex-disaggregated and etiology-disaggregated analyses were performed.Results99.1% (424/428) of PEA-associated lesions localized to lower lobes, predominantly left-sided (43.5%). Immediate hemostasis achieved in 95%, 1-month recurrence rate 5.1% (22/428). Multivariate Cox regression identified predictors: massive hemoptysis (HR = 2.03), ectopic bronchial arteries (HR = 1.54), thrombocytosis (>215 × 109/L, HR = 1.27). Sex-disaggregated analysis revealed significant differences in weight (p < .001) and platelet counts (p = .023) between males and females. Etiology-based analysis showed higher recurrence rates in neoplastic (33.3%) and infectious-inflammatory (6.0%) etiologies compared to vascular diseases (0%). No spinal ischemia or bronchoesophageal fistulae.ConclusionPEA embolization using tailored PVA particles represents a safe and effective intervention for lower lobe hemoptysis, warranting systematic evaluation in all such cases. Sex-disaggregated analysis is essential for accurate risk stratification. Embolization outcomes are significantly influenced by underlying etiology, with infectious diseases requiring concurrent antimicrobial therapy and neoplastic lesions demanding anti-tumor treatment for durable outcomes.