Bronchial artery embolization in the management of hemoptysis in cystic fibrosis

Abstract

Massive hemoptysis and/or recurrent expectoration of measurable amounts of blood are common complications of chronic bronchopulmonary infections in cystic fibrosis (CF). When conservative treatment fails to control bleeding, surgery or bronchial artery embolization (BAE) is frequently considered. We present our experience and long-term follow up of BAE in 14 CF patients (age range 15-39 years) with massive (6 subjects) and/or recurrent (8 subjects) hemoptysis not responsive to medical treatment. Seven had chronic hypercapnic respiratory failure. After angiographic evaluation, polyvinyl alcohol particles (Ivalon) were injected to embolize obviously enlarged bronchial arteries. Seventeen procedures were performed in 14 patients and 36 bronchial arteries were embolized. All the patients stopped bleeding immediately upon BAE. Most of the patients had postembolization fever, dysphagia, and transient chest pain which were managed symptomatically. After a median follow-up period of 10.5 months (range 0.5-38 months), no recurrence of hemoptysis was observed in 8 patients who are still alive. In 3 patients hemoptysis recurred and they underwent reembolization after 3, 22, and 25 months, respectively. Three subjects died of respiratory failure within 5 months from BAE. Presently, 50% of patients studied had a > or = 1 year interval free of major hemoptysis after the first BAE. Our experience indicates that massive and/or recurrent hemoptysis in CF patients can be safety and effectively managed by BAE if the procedure is performed by a skilled practitioner. The procedure was well tolerated and resulted in prolonged and satisfactory bleeding control in most patients.

Bronchial Artery Embolization for Hemoptysis in Young Patients with Cystic Fibrosis

“…Percutaneous bronchial artery embolization (BAE) has been shown to be a safe and effective method of controlling hemoptysis in patients with (4,6,10,11,14 -17) and in those without (18,19) CF. However, the superiority of BAE over conservative therapy in reducing the rate of long-term recurrence of major hemoptysis and in improving survival has not yet been proven (17,20).…”

Treatment of Recurrent Severe Hemoptysis in Cystic Fibrosis with Tranexamic Acid

“…Conservative therapy has been demonstrated to be effective [7]; however, BAE is the preferred therapy as it can result in immediate control of the bleeding and can potentially prevent a massive hemorrhage that portends a poor outcome [4, 5, 8, 9, 10, 11]. Premarin, pitressin, and bronchoscopy are other potential therapeutic options; however, no controlled studies have been performed demonstrating efficacy [5].…”

A study of lung resection for haemoptysis with or without pre-operative bronchial artery embolisation

“…18 The procedure was well tolerated and resulted in prolonged and satisfactory bleeding control in most patients.…”