Long-Term Outcomes of Bronchial Artery Embolization for Patients with Non-Mycobacterial Non-Fungal Infection Bronchiectasis

Abstract

<b><i>Background:</i></b> There is no study on the predictive factors of recurrent haemoptysis after bronchial artery embolization (BAE) with the long-term outcomes in patients with bronchiectasis (BE). <b><i>Objectives:</i></b> To evaluate the long-term outcomes of BAE in BE patients without accompanying refractory active infection of mycobacteriosis and aspergillosis with analysis for the predictive factors of recurrent haemoptysis. <b><i>Methods:</i></b> Data of 106 patients with BE who underwent BAE using coils between January 2011 and December 2018 were retrospectively reviewed. The cumulative haemoptysis control rate was estimated using Kaplan-Meier methods with log-rank tests to analyze differences in recurrence-free rate between groups based on technical success and failure, bacterial colonization status, number of BE lesions, and vessels embolized to bronchial arteries (BAs) or BAs + non-bronchial systemic arteries (NBSAs). <b><i>Results:</i></b> Bacterial colonization was detected in approximately 60% of patients. Computed tomography showed bronchiectatic lesions with 2.9 ± 1.4 lobes. In the first series of BAE, embolization was performed in the BAs alone and BAs + NBSAs in 65.1 and 34.9% of patients, respectively, with 2.4 ± 1.4 embolized vessels in total. The median follow-up period was 1,000 (7–2,790) days. The cumulative haemoptysis control rates were 91.3, 84.2, 81.5, and 78.9% at 1, 2, 3, and 5 years, respectively. The haemoptysis control rates were higher in the technical success group than in the technical failure group (<i>p</i> = 0.029). <b><i>Conclusions:</i></b> High haemoptysis control rates for long-term periods were obtained by embolization for all visualized abnormal arteries, regardless of the colonization status, number of bronchiectatic lobes, and target vessels, irrespective of NBSAs.

Pseudomonas aeruginosa isolation is an important predictor for recurrent hemoptysis after bronchial artery embolization in patients with idiopathic bronchiectasis: a multicenter cohort study

“…All 588 patients in this study were idiopathic bronchiectasis patients, and this is the first study to our knowledge assessing a single aetiology on BAE and hemoptysis recurrence. The cumulative recurrent severe hemoptysis rates in this study were similar to previous studies [ 12 , 13 , 18 ]. The recurrence rate of hemoptysis in patients with bronchiectasis was lower than in patients with mycobacterium, fungal infection, or a post-tuberculous phenotype of bronchiectasis [ 20 , 21 ].…”

“…Recurrent hemoptysis was defined as the expectoration of blood alone without mucus from the airways or lung parenchyma after BAE [ 17 ]. Recurrent severe hemoptysis was defined as hemoptysis requiring repeated BAE, lobectomy, or death from hemoptysis after BAE [ 18 ]. Recurrence-free time was calculated from the date of BAE to the date of recurrence, death, or last follow-up.…”

“…All doctors received the same treatment procedure training [ 19 ] by designated radiologists of Shanghai Pulmonary Hospital, the special pulmonary vascular interventional center in China that experience with about 10,000 cases with BAE and more than 1000 cases per year. First, CTA (slice thickness, 0.625 or 1 mm; slice gap, 0.625 or 1 mm) was performed prior to BAE to assess lung lesions and possible relevant arteries [ 18 ]. Second, angiography was performed through various types of 4F or 5F catheters based on the CTA findings through the femoral artery to confirm relevant arteries.…”

Dual-vessel intervention treatment for massive hemoptysis caused by lung cavitary lesions

“…Sopko et al also reported a similar recurrence rate, ranging from 10 to 55% after 46 months of follow-up [2]. The recurrence rate was significantly higher in patients with aspergilloma and cavitary lesions than in those with bronchiectasis, TB, or lung malignancies [5,6]. In recent years, the proportion of massive hemoptysis cases caused by fungal infections has gradually increased in patients with cavitary lung disease [10].…”

“…The recurrence rate following BAE can be as high as 57.5% at the one-year follow-up. Aspergilloma and cavitary lesions are considered to have the highest recurrence rate [5], but nonmycobacterial and nonfungal infection-induced bronchiectasis causing hemoptysis could reach control rates as high as 91.3 and 78.9% at 1 and 5 years, respectively [6]. Very few studies have focused on patients with massive hemoptysis caused by cavitary lung lesions who underwent BAE.…”