Bronchial artery embolization in adults with cystic fibrosis: impact on the clinical course and survival.
OBJECTIVE
Although bronchial artery embolization (BAE) is effective in the acute control of recurrent or major hemoptysis in adults with cystic fibrosis, outcomes after embolization are not well known. The objective of this retrospective study was to evaluate respiratory function, survival, and hemoptysis-free survival in adult patients with cystic fibrosis treated for hemoptysis with BAE.


METHODS
Of 297 patients with cystic fibrosis hospitalized from 1990 to 2004, 30 patients (mean age, 26.7+/-9.2 years) presented with major or persistent hemoptysis that required 42 BAE sessions. These patients were compared with a control group of 27 patients without hemoptysis requiring embolization who were matched for age, sex, and forced expiratory volume in 1 second (FEV1).


RESULTS
Hemoptysis stopped within 24 hours after BAE in 96.6% of patients (n=29), and there were no major complications. The change in the slope of FEV1 after the BAE or matching date was significantly worse in the embolization group (P=.0007). At last follow-up, nine and one patients, respectively, had undergone lung transplantation in the BAE and control groups (P=.002). The 5-year survival rates without lung transplantation were 31% and 84%, respectively, in the BAE and control groups (hazard ratio, 5.95; P=.002). Sixty-two percent of patients were free of hemoptysis 5 years after BAE. The number of collateral arteries was the only factor associated with the risk of death or recurrent hemoptysis (P=.001).


CONCLUSIONS
Despite the effectiveness of embolization in controlling recurrent or major hemoptysis, adults with cystic fibrosis who have undergone BAE for hemoptysis are at much higher risk of respiratory function aggravation, death, and the need for lung transplantation than those who have not undergone BAE for hemoptysis. They are more likely to die or to undergo lung transplantation than to present with recurrent major hemoptysis.
Vidal
Vincent
V
Department of Radiology, Hôpital Timone, Marseille, France, and Department of Radiology, Centre Hospitalier de l'Université de Montréal, Quebec, Canada.
Therasse
Eric
E
Berthiaume
Yves
Y
Bommart
Sébastien
S
Giroux
Marie-France
MF
Oliva
Vincent L
VL
Abrahamowicz
Michal
M
du Berger
Roxane
R
Jeanneret
Alphonse
A
Soulez
Gilles
G
D000328:Adult; D001981:Bronchial Arteries; D016022:Case-Control Studies; D003550:Cystic Fibrosis / Q000150:complications*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006469:Hemoptysis / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome