Abstract No. 664 Elective bronchial artery embolization for hemoptysis in cystic fibrosis: is there a benefit over emergent embolization?

Abstract

Hemoptysis is a well known complication of late stage cystic fibrosis, and can be acutely life threatening if not appropriately treated. Bronchial artery embolization (BAE) has become a first line treatment for patients with life threatening hemoptysis or those refractory to conservative management. However its use for non-critical management of hemoptysis remains unclear. This study compares outcomes between emergent procedures performed for life threatening hemoptysis and elective procedures performed for non life threatening hemoptysis in cystic fibrosis patients. A retrospective chart review of 34 bronchial artery embolization in 18 patients was performed. Procedures were subdivided into two groups – those requiring emergent procedures for life threatening hemoptysis and those who received elective procedures for nonlife threatening hemoptysis. Emergent was defined as massive hemoptysis (>250cc/24h) or hemodynamic instability. Pre-procedure variables, procedure variables, and outcomes were analyzed. There was no significant correlation between disease severity and amount of hemoptysis or outcomes. All but one patient had positive sputum cultures. BAE was performed emergently in 8 cases and electively in 26. Seven patients required re-embolization on 16 different instances. The average time between re-embolization was 249 days in the elective group and 93 days in the emergent group, although results did not show statistical significance (p=0.6). A lower rate of ICU admission was seen in the elective group compared to the emergent group (p=0.001). The average length of stay after procedure was 9.8 days in the elective group compared to 23.4 days for the emergent group, although results were not significant (p=0.15). There was a trend towards significance with decreased number of patients requiring intubation in the elective group (p=0.09). Bronchial artery embolization is a viable and effective technique for treatment of non–life-threatening hemoptysis in cystic fibrosis patients. Benefits of early intervention before hemoptysis becomes life threatening may offer advantages, and further research is needed.