title: Deaths Related to Bronchial Arterial Embolization in Patients With Cystic Fibrosis: Three Cases and an Institutional Review.
abstract: Cystic fibrosis (CF) patients are at risk for life-threatening hemoptysis, sometimes necessitating bronchial arterial embolization (BAE). Spinal artery embolization and pulmonary infarction are commonly cited procedural risks, yet respiratory failure and death are underappreciated. We conducted a retrospective institutional review of our outcomes after BAE for hemoptysis in CF and present three cases highlighting this complication. From 2007 to 2015, 12 patients underwent 17 BAE procedures for hemoptysis at our institution. Three patients experienced respiratory failure and died within 3 months of BAE. Nonsurvivors had significantly lower baseline FEV1values than survivors (21.8% vs 52.6%, P < .05). BAE as a treatment for life-threatening hemoptysis may precipitate respiratory failure in end-stage CF and should accelerate the evaluation for lung transplantation. Institutions should reevaluate their BAE practices to ensure preservation of the bronchial circulation, which contributes to gas exchange in these patients.
authors.affiliation: Division of Pulmonary and Critical Care, Department of Medicine, University of Washington, Seattle, WA. Electronic address: townj@u.washington.edu.
authors.forename: James A
authors.initials: JA
authors.lastname: Town
authors.affiliation: Department of Radiology, Seattle Childrens, Seattle, WA.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Monroe
authors.affiliation: Division of Pulmonary and Critical Care, Department of Medicine, University of Washington, Seattle, WA.
authors.forename: Moira L
authors.initials: ML
authors.lastname: Aitken
mesh_terms: D000328:Adult; D001981:Bronchial Arteries; D003550:Cystic Fibrosis / Q000150:complications*; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D005260:Female; D005541:Forced Expiratory Volume; D006469:Hemoptysis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D011659:Pulmonary Gas Exchange; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality*; D012189:Retrospective Studies; D055815:Young Adult
keywords: bronchial artery embolization; bronchial circulation; cystic fibrosis; hemoptysis