Autor:innen:
M. Dohna (Hannover, DE)
D. Renz (Hannover, DE)
F. Stehling (Essen, DE)
C. Dohna-Schwake (Essen, DE)
S. Sutharsan (Essen, DE)
C. Neurohr (Gerlingen, DE)
H. Wirtz (Leipzig, DE)
O. Eickmeier (Frankfurt am Main, DE)
J. Grosse-Onnebrink (Münster, DE)
A. Sauerbrey (Erfurt, DE)
V. Soditt (Solingen, DE)
K. Poplawska (Mainz, DE)
F. Wacker (Hannover, DE)
M. Montag (Münster, DE)
Introduction: Massive hemoptysis is a life-threatening event in advanced cystic fibrosis lung disease (CF) occurring mainly in patients with advanced disease and also in children and adolescents. Bronchial artery embolization (BAE) is the standard of care treatment. Patients treated with microsphere particles for BAE are at higher risk for respiratory aggravation, lung transplant and death. Aim of our study was to scrutinize short and long-term outcome of patients with CF and hemoptysis after BAE using coils.
Methods: We carried out a retrospective cohort study of 34 adult patients treated for massive hemoptysis with super selective bronchial artery coil embolization (ssBACE) between 1/2008 and 2/2015. Embolization protocol was restricted to the culprit vessel(s) and three lobes maximum . Demographic data, functional end-expiratory volume in 1 second in % predicted (FEV1% pred.) and Body mass index before and after ssBACE, sputum colonization, procedural data, time to transplant and time to death were documented.
Results: Patients treated with ssBACE showed significant improvement of FEV1% pred. after embolization (p = 0.004) with 72.8% alive five years post ssBACE. Mean age of patients was 29,9 years (±7,7 ). Mean FEV1% pred. was 45,7% (±20,1). Median survival to follow-up was 75 months (0-125). Severe complication rate was 0%, recanalization rate 8.8% and 5-year-reintervention rate 58.8%. Chronic infection with Pseudomonas aeruginosa was found in 79.4%, Staphalococcus areus in 50% and Aspergillus fumigatus in 47.1%.
Discussion: ssBACE is a safe and effective treatment for massive hemoptysis in patients with CF with good results for controlling hemostasis and excellent short and long-term survival, especially in severely affected patients with FEV1 <40% pred. We think the data of our study support the use of coils and a protocol of careful and prudent embolization.