Chest
Bronchial Artery Embolization for Severe Hemoptysis in Cystic Fibrosis
Section snippets
MATERIALS AND METHODS
Ten female and 15 male patients, aged 7 to 35 years (mean, 21 years) underwent BAE for severe hemoptysis. The indications for BAE and the technique used have been described.1 We no longer routinely submit patients to bronchoscopy before BAE to localize the source of bleeding. Attempts are made to occlude any abnormal, enlarged bronchial artery identifiable at angiography. Only patients with severe hemoptysis were considered; the 25 patients either had acute hemorrhage (immediately
Immediate Outcome
Twenty-one (84 percent) of 25 patients completely stopped bleeding immediately upon BAE (Fig 1). The other four (16 percent) continued to bleed, although less briskly than prior to BAE. Hemoptysis stopped after repeat BAE ten days later in one patient (case 7), two had ongoing, intermittent, spontaneously resolving minor (case 8) to moderate (case 19) hemoptysis, and the fourth (case 22) had moderate to severe hemoptysis which led to surgical removal of the bleeding right upper lobe.
Survival
Six
Technique
Gelatin (Gelfoam) has been our embolic agent of choice primarily because it is easily injected. We believe that it is necessary to inject a large number of small particles (usually 15 to 80 per artery) in order to occlude the bronchial vessels peripherally and completely. It is known that gelatin is not a permanent occluder and that resorption and recanalization take place over several weeks or months;7 however, the alternative material, polyvinyl alcohol (Ivalon), a more permanent occluder, is
ACKNOWLEDGEMENT
We thank Michael Feldstein, Ph.D., for instruction concerning the statistical test for censored data; Harvey Colten, M.D., for constructive suggestions; and Mary Ellen B. Wohl, M.D., for critical review of the manuscript.
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Cited by (50)
Bronchial Artery Embolization in Pediatric Pulmonary Hemorrhage: A Single-Center Experience
2020, Journal of Vascular and Interventional RadiologyDeaths Related to Bronchial Arterial Embolization in Patients With Cystic Fibrosis: Three Cases and an Institutional Review
2016, ChestCitation Excerpt :Thus the 25% mortality of our cohort is consistent with these studies and adds to this information as we tracked the physiologic changes of respiratory failure (Fig 3). The attributable mortality of massive hemoptysis in CF is reported as 5% to 16%12,14; therefore we and others15 believe that in patients with severely reduced baseline respiratory function, BAE therapy may be more dangerous than the disease. For patients with limited lung function, we recommend expediting the transplant evaluation at the onset of hemoptysis.
Pulmonary hemorrhage: A novel mode of therapy
2009, Respiratory MedicineCitation Excerpt :A bronchial artery embolism (BAE) applies mainly for local bleeding when an abnormal vessel is documented in medical centers with a stand-by angiographic service. The last resort for significant bleeding is a surgical procedure.5–7,16,17 The management of bleeding from an unidentifiable source, on the other hand, is more complicated.
Hemoptysis in Israeli CF patients - Prevalence, treatment, and clinical characteristics
2008, Journal of Cystic FibrosisHaemoptysis and bronchial artery embolization in children
2008, Paediatric Respiratory ReviewsCitation Excerpt :Lung resection is an effective treatment for haemoptysis due to localized disease,18 but it is rarely appropriate in children with diffuse diseases such as CF.17 The usual indication for BAE in children is an immediate threat to life when other treatments have failed.5 Various authors have proposed thresholds for intervention based on the volume of expectorated blood.
Pulmonary surgery in cystic fibrosis
2008, Seminars in Pediatric Surgery
Manuscript received August 7; revision accepted November 9.