Bronchial Artery Embolization for Hemoptysis in Young Patients with Cystic Fibrosis

Barben, Juerg; Robertson, David; Olinsky, Anthony; Ditchfield, Michael

doi:10.1148/radiol.2241010654

Cited by 88 publications

(54 citation statements)

References 31 publications

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“…Life threatening massive haemoptysis is successfully treated in the short term with bronchial artery embolisation [8,9]. However, 55% of patients with cystic fibrosis required more than one embolisation procedure to achieve long-term control of their haemoptysis [8].…”

Section: Discussionmentioning

confidence: 99%

Emergency percutaneous transcatheter embolisation of acute arterial haemorrhage

et al. 2009

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Section: Discussionmentioning

confidence: 99%

Emergency percutaneous transcatheter embolisation of acute arterial haemorrhage

et al. 2009

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“…From a practical standpoint, the noninvasive approach provided by CTA is expected to modify the recommendations for the angiographic procedures according to which thoracic aortography should be performed before [23] or after [24] bronchial artery embolization to identify all the systemic arterial supply to the bleeding site. Owing to the possibility to detect not only ectopic bronchial arteries, but also abnormal nonbronchial systemic arteries [10,25], CTA should contribute to the improvement of the immediate success rate of embolization whatever the underlying disease [26][27][28][29][30][31][32]. In three patients of our study group, the instable Fig.…”

Section: Discussionmentioning

confidence: 99%

Ectopic origin of bronchial arteries: assessment with multidetector helical CT angiography

et al. 2007

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The purpose of this study was to determine non-invasively the frequency of ectopic bronchial arteries (BA) (i.e., bronchial arteries originating at a level of the descending aorta other than T5-T6 or from any aortic collateral vessel) on multidetector-row CT angiograms (CTA) obtained in patients with hemoptysis. Over a 5-year period (2000-2005), 251 consecutive patients with hemoptysis underwent multidetector-row CT angiography of the thorax. From this population, 37 patients were excluded because of a suboptimal CTA examination (n = 19), the presence of extensive mediastinal disease (n = 15) or severe chest deformation (n = 3) precluding any precise analysis of the bronchial arteries at CTA. Our final study group included 214 patients who underwent a thin-collimated CT angiogram (contrast agent: 300 to 350 mg/ml) on a 4- (n = 56), 16- (n = 119) and 64- (n = 39) detector-row scanner. The site of origin and distribution of bronchial arteries were analyzed on transverse CT scans, maximum intensity projections and volume-rendered images. The site of the ostium of a bronchial artery was coded as orthotopic when the artery originated from the descending aorta between the levels of the fifth and sixth thoracic vertebrae; all other bronchial arteries were considered ectopic. From the studied population, 137 (64%) patients had only orthotopic bronchial arteries, whereas 77 patients (36%) had at least one bronchial artery of ectopic origin. A total of 147 ectopic arteries were depicted, originating as common bronchial trunks (n = 23; 19%) or isolated right or left bronchial arteries (n = 101; 81%). The most frequent sites of origin of the 124 ostiums were the concavity of the aortic arch (92/124; 74%), the subclavian artery (13/124; 10.5%) and the descending aorta (10/124; 8.5%). The isolated ectopic bronchial arteries supplied the ipsilateral lung in all but three cases. Bronchial artery embolization was indicated in 26 patients. On the basis of CTA information, (1) bronchial embolization was attempted in 24 patients; it was technically successful in 21 patients (orthotopic BAs: 6 patients; orthotopic and ectopic BAs: 3 patients; ectopic BAs: 12 patients) and failed in 3 patients due to an instable catheterization of the ectopic BAs; the absence of additional bronchial arterial supply and no abnormalities of nonbronchial systemic arteries at CTA avoided additional arteriograms in these 3 patients; (2) owing to the iatrogenic risk of the embolization procedure of ectopic BAs, the surgical ligation of the abnormal vessels was the favored therapeutic option in 2 patients. This study enabled the depiction of ectopic bronchial arteries in 36% of the studied population, important anatomical information prior to therapeutic decision making.

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“…Immediate control of hemoptysis with BAE has been reported in 57–100% of patients [12,26,44,113,114,115,116,117,118,119,120,121]. This wide range of success rates across studies can be partially attributed to heterogeneity with regard to analysis of results [122].…”

Section: Management Of Massive Hemoptysismentioning

confidence: 99%

“…Barben et al [121] reported the need of a second embolization in 55% (11/20) of their cystic fibrosis patients, with a median time interval of 4 months between the first and second procedures. Recurrence of hemoptysis may be due to incomplete embolization of the bronchial vessels, recannalization of the embolized arteries, presence of nonbronchial systemic arteries, or development of collateral circulation in response to continuing pulmonary inflammation [12,114,115,123].…”

Section: Management Of Massive Hemoptysismentioning

confidence: 99%

Massive Hemoptysis: An Update on the Role of Bronchoscopy in Diagnosis and Management

Sakr

Dutau²

2010

Respiration

223

187

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Hemoptysis is frequently encountered in clinical practice, and may be the presenting symptom of a number of diseases. Although massive hemoptysis accounts for only 5–15% of episodes, it should always be considered as a life-threatening condition that warrants effective assessment and management. In this article, we review the literature with regard to the definition, etiology, epidemiology, pathophysiology, diagnosis and treatment of massive hemoptysis, with special emphasis on the role of bronchoscopy as a diagnostic and therapeutic tool. We briefly present the circumstances under which the use of rigid bronchoscopy should be preferred for controlling massive bleeding. Moreover, we address the crucial importance of multidisciplinary collaboration by illustrating the roles of endovascular therapy and surgery in the optimal management of massive hemoptysis.

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Bronchial Artery Embolization for Hemoptysis in Young Patients with Cystic Fibrosis

Abstract: BAE had a high success rate for short-term control of bleeding; however, more than half the patients required repeat embolization during the long-term follow-up.

Cited by 88 publications

References 31 publications

Emergency percutaneous transcatheter embolisation of acute arterial haemorrhage

Emergency percutaneous transcatheter embolisation of acute arterial haemorrhage

Ectopic origin of bronchial arteries: assessment with multidetector helical CT angiography

Massive Hemoptysis: An Update on the Role of Bronchoscopy in Diagnosis and Management

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