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Rofo 2016; 188(11): 1061-1066
DOI: 10.1055/s-0042-112227
Interventional Radiology
© Georg Thieme Verlag KG Stuttgart · New York

Bronchial Artery Embolization in Hemoptysis: 10-Year Survival and Recurrence-Free Survival in Benign and Malignant Etiologies – A Retrospective Study

Bronchialarterienembolisation bei Hämoptysen: 10-Jahresüberleben und rezidivfreies Überleben bei benigner und maligner Genese – eine retrospektive Analyse
R. Syha
1   Diagnostic and Interventional Radiology, University Hospital Tuebingen, Germany
,
T. Benz
1   Diagnostic and Interventional Radiology, University Hospital Tuebingen, Germany
,
J. Hetzel
2   Internal Medicine II, Department of Oncology, Haematology, Clinical Immunology, Rheumatology and Pneumology, University of Tuebingen, Germany
,
W. Spengler
2   Internal Medicine II, Department of Oncology, Haematology, Clinical Immunology, Rheumatology and Pneumology, University of Tuebingen, Germany
,
M. J. Kohlhäufl
3   Center for Pulmonology and Thoracic Surgery, Division of Pulmonology, Klinik Schillerhoehe, Gerlingen, Germany
,
S. Gatidis
1   Diagnostic and Interventional Radiology, University Hospital Tuebingen, Germany
,
G. Grözinger
1   Diagnostic and Interventional Radiology, University Hospital Tuebingen, Germany
,
M. Horger
1   Diagnostic and Interventional Radiology, University Hospital Tuebingen, Germany
,
K. Nikolaou
1   Diagnostic and Interventional Radiology, University Hospital Tuebingen, Germany
,
D. Ketelsen
1   Diagnostic and Interventional Radiology, University Hospital Tuebingen, Germany
› Author Affiliations
Further Information

Publication History

25 April 2016

04 July 2016

Publication Date:
19 October 2016 (online)

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Abstract

Purpose: The aim of the study was to evaluate safety, effectiveness, recurrence rate and 10-year survival after bronchial artery embolization (BAE) in benign and malignant etiologies.

Methods: The retrospective study includes 100 BAE procedures in 88 patients. Underlying disease was classified as benign (n = 67) and malignant (n = 21) etiologies. Immediate bleeding control and procedure safety were evaluated in all patients. In 51 (58 %) patients, follow-up data with a median follow-up time of 1015 days (range, 494 to 3727 days) were acquired to assess overall survival, time-to-recurrence of bleeding and recurrence-free survival, using Kaplan-Maier estimates to compare differences between both subgroups.

Results: Immediate bleeding control was achieved after 96/100 procedures (96 %), with a minor complication rate of 5.0 %. No major complications occurred. The overall survival was 74 % after 1 year and 59 % after 5 years and 10 years. There was a significant difference in survival between the malignant and benign groups (p < 0.0001). Survival was 90 %, 80 % and 76 % at 1 year, 3 years and 10 years, respectively, in the benign group and 18 % and 0 % at 1 year and 3 years, respectively in the malignant group. The median time to recurrence of bleeding and recurrence-free survival were 239 days and 94 % after 1 year and 87 % after 10 years in the benign group, compared to 66 days and 34 % after 1 year and 0 % after 3 years in the malignant group (p = 0.0107).

Conclusion: BAE is a safe and highly effective treatment option in hemoptysis. However, the recurrence rate and survival are highly dependent on the underlying disease.

Key Points:

• BAE is a safe and highly effective treatment option in hemoptysis.

• Recurrence rate and survival are strongly dependent on the underlying disease with significantly impaired results in patients with malignant diseases.

• Coil embolization is an effective BAE treatment method. Nevertheless, it should be mentioned, that reinterventions can be impeded, if embolization is performed in the proximal part of bronchial arteries.

Citation Format:

• Syha R, Benz T, Hetzel J et al. Bronchial Artery Embolization in Hemoptysis: 10-Year Survival and Recurrence-Free Survival in Benign and Malignant Etiologies – A Retrospective Study. Fortschr Röntgenstr 2016; 188: 1061 – 1066

Zusammenfassung

Hintergrund: Ziel der Studie war die Evaluation der Bronchialarterienembolisation (BAE) in der Behandlung von Hämoptysen benigner oder maligner Genese bezüglich Sicherheit, Effektivität, Rezidivrate und der 10-Jahres-Überlebensrate.

Material und Methoden: Die retrospektive Studie analysiert 100 BAE Prozeduren bei 88 Patienten. Die Grunderkrankung wurde als benigne (n = 67) oder maligne (n = 21) klassifiziert. Der technische Erfolg (sofortige Blutungskontrolle) und die Sicherheit der Prozedur wurde bei allen Patienten analysiert. Bei 51 Patienten (58 %) konnten Follow-up Daten mit einem medianen Follow-up von 1015 Tagen (range, 494 to 3727 Tagen) akquiriert werden (overall-survival, time-to-recurrence, recurrence-free survival), um Unterschiede zwischen den Subgruppen mittels Kaplan-Maier-Kurven zu analysieren.

Ergebnisse: Eine sofortige Blutungskontrolle konnte bei 96/100 Prozeduren erzielt werden. Die Minor-Komplikationsrate betrug 5,0 % bei keinen Major-Komplikationen. Das Overall-survival betrug 74 % nach einem Jahr und 59 % nach 5 und 10 Jahren mit signifikanten Unterschieden zwischen der malignen und benignen Subgruppe (p < 0,0001). Das Overall-survival war 90 % (1 Jahr), 80 % (3 Jahre) und 76 % (10 Jahre) in der benignen und 18 % (1 Jahr) und 0 % (3 Jahre) in der malignen Subgruppe. Die mittlere time-to-recurrence und das recurrence-free-survival war 239 Tage und 94 % nach 1 Jahr und 87 % nach 10 Jahren (benigne Subgruppe) verglichen zu 66 Tagen und 34 % nach 1 Jahr und 0 % nach 3 Jahren (maligne Subgruppe) (p = 0,0107).

Schlussfolgerung: Die BAE ist eine sichere und effektive Therapieoption bei Hämoptysen. Der Langzeiterfolg ist jedoch abhängig von der Grunderkrankung.

Kernaussagen:

• Die BAE ist eine sichere und effektive Therapieoption bei Hämoptysen.

• Die Rezidivrate und das Überleben nach BAE ist abhängig von der Grunderkrankung mit signifikant schlechteren Ergebnissen bei maligner Ätiologie.

• Die Coilembolisation ist eine effektive Möglichkeit der BAE. Jedoch muss darauf hingewiesen werden, dass eine inital zentrale Embolisation der Bronchialarterie zu vermeiden ist, um Reinterventionen zu ermöglichen.

Key words

broncial artery embolization - subgroup analysis - benign etiology - malignant etiology
 

  • References

  • 1 Andrejak C, Parrot A, Bazelly B et al. Surgical lung resection for severe hemoptysis. The Annals of thoracic surgery 2009; 88: 1556-1565
    CrossrefPubMedGoogle Scholar
  • 2 Knott-Craig CJ, Oostuizen JG, Rossouw G et al. Management and prognosis of massive hemoptysis. Recent experience with 120 patients. The Journal of thoracic and cardiovascular surgery 1993; 105: 394-397
    PubMedGoogle Scholar
  • 3 Ittrich H, Klose H, Adam G. Radiologic management of haemoptysis: diagnostic and interventional bronchial arterial embolisation. Rofo 2015; 187: 248-259
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Chen J, Chen LA, Liang ZX et al. Immediate and long-term results of bronchial artery embolization for hemoptysis due to benign versus malignant pulmonary diseases. Am J Med Sci 2014; 348: 204-209
    CrossrefPubMedGoogle Scholar
  • 5 Chun JY, Morgan R, Belli AM. Radiological management of hemoptysis: a comprehensive review of diagnostic imaging and bronchial arterial embolization. Cardiovascular and interventional radiology 2010; 33: 240-250
    CrossrefPubMedGoogle Scholar
  • 6 Alexander GR. A retrospective review comparing the treatment outcomes of emergency lung resection for massive haemoptysis with and without preoperative bronchial artery embolization. Eur J Cardiothorac Surg 2014; 45: 251-255
    CrossrefPubMedGoogle Scholar
  • 7 Shao H, Wu J, Wu Q et al. Bronchial artery embolization for hemoptysis: a retrospective observational study of 344 patients. Chin Med J (Engl) 2015; 128: 58-62
    CrossrefPubMedGoogle Scholar
  • 8 Barben J, Robertson D, Olinsky A et al. Bronchial artery embolization for hemoptysis in young patients with cystic fibrosis. Radiology 2002; 224: 124-130
    CrossrefPubMedGoogle Scholar
  • 9 Chun JY, Belli AM. Immediate and long-term outcomes of bronchial and non-bronchial systemic artery embolisation for the management of haemoptysis. European radiology 2010; 20: 558-565
    CrossrefPubMedGoogle Scholar
  • 10 Kim SW, Lee SJ, Ryu YJ et al. Prognosis and Predictors of Rebleeding After Bronchial Artery Embolization in Patients with Active or Inactive Pulmonary Tuberculosis. Lung 2015; 193: 575-581
    CrossrefPubMedGoogle Scholar
  • 11 Kim YG, Yoon HK, Ko GY et al. Long-term effect of bronchial artery embolization in Korean patients with haemoptysis. Respirology 2006; 11: 776-781
    CrossrefPubMedGoogle Scholar
  • 12 Anuradha C, Shyamkumar NK, Vinu M et al. Outcomes of bronchial artery embolization for life-threatening hemoptysis due to tuberculosis and post-tuberculosis sequelae. Diagnostic and interventional radiology 2012; 18: 96-101
    PubMedGoogle Scholar
  • 13 Garcia-Olive I, Sanz-Santos J, Centeno C et al. Results of bronchial artery embolization for the treatment of hemoptysis caused by neoplasm. J Vasc Interv Radiol 2014; 25: 221-228
    CrossrefPubMedGoogle Scholar
  • 14 Woo S, Yoon CJ, Chung JW et al. Bronchial artery embolization to control hemoptysis: comparison of N-butyl-2-cyanoacrylate and polyvinyl alcohol particles. Radiology 2013; 269: 594-602
    CrossrefPubMedGoogle Scholar
  • 15 Garcia-Olive I, Sanz-Santos J, Centeno C et al. Predictors of recanalization in patients with life-threatening hemoptysis requiring artery embolization. Arch Bronconeumol 2014; 50: 51-56
    PubMedGoogle Scholar
  • 16 Lorenz J, Sheth D, Patel J. Bronchial artery embolization. Semin Intervent Radiol 2012; 29: 155-160
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Chan VL, So LK, Lam JY et al. Major haemoptysis in Hong Kong: aetiologies, angiographic findings and outcomes of bronchial artery embolisation. The international journal of tuberculosis and lung disease: the official journal of the International Union against Tuberculosis and Lung Disease 2009; 13: 1167-1173
    PubMedGoogle Scholar
  • 18 Lee S, Chan JW, Chan SC et al. Bronchial artery embolisation can be equally safe and effective in the management of chronic recurrent haemoptysis. Hong Kong medical journal = Xianggang yi xue za zhi/Hong Kong Academy of Medicine 2008; 14: 14-20
    PubMedGoogle Scholar