BRONCHIAL ARTERY EMBOLIZATION FOR THE TREATMENT OF HEMOPTYSIS IN PATIENTS WITH CYSTIC-FIBROSIS

Hemoptysis is common in patients with cystic fibrosis (CF). Bleeding m ay vary in severity, ranging from minor blood-streaking of sputum to e xpectoration of significant quantities of blood. Major hemoptysis, def ined as bleeding greater than 240 ml/24 h, represents a medical emerge ncy. Bronchial artery embolization (BAE) is one of the treatment optio ns for hemoptysis. We reviewed the 10-yr experience at the University of North Carolina Hospitals in the treatment of hemoptysis by BAE. Eig hteen patients with CF were hospitalized on 29 occasions and underwent 36 BAE procedures for the control of hemoptysis. Most patients (n = 1 1) had very severe lung disease (FEV1 < 35%) with a high incidence (n = 9, 50%) of multi-drug-resistant bacteria. Fifteen patients (n = 33 p rocedures) were followed for a mean of similar to 22 mo after BAE. The overall efficacy of BAE for initial control of hemoptysis was 75% (n = 22) after one session, 89% (n = 26) after two sessions, and 93% (n = 27) after three sessions. The overall recurrence rate per episode was 46% (12/26 presentations in four patients) with a mean time for recur rence of similar to 12 mo. There was a high incidence (75%) of bleedin g from nonbronchial systemic collateral vessels among patients (n = 7) who had undergone a previous BAE. There were two deaths associated wi th massive hemoptysis despite BAE. Three patients had transient neurol ogic deficits during BAE. We concluded that BAE is a relatively safe a nd effective means of treating significant hemoptysis in patients with CF.