CHEST Guidelines-Deaths-Related-to-Bronchial-Arterial-Embolization-

Deaths-Related-to-Bronchial-Arterial-Embolization-

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The document discusses complications arising from bronchial arterial embolization (BAE) in cystic fibrosis (CF) patients who experience life-threatening hemoptysis. The authors conducted a retrospective review spanning from 2007 to 2015, focusing on the outcomes of 17 BAE procedures performed on CF patients at their institution. Notably, three patients suffered respiratory failure and died within three months post-procedure, typically characterized by critically low baseline FEV1 levels (average 21.8%) compared to survivors (average 52.6%).<br /><br />BAE is a recognized intervention for managing severe hemoptysis in CF, yet risks like spinal artery embolization and pulmonary infarction are often emphasized over respiratory failure—which the study underscores as significant. In advanced CF, the bronchial artery's role in gas exchange intensifies due to increased angiogenesis, meaning BAE can inadvertently induce respiratory failure by disrupting critical blood flow dynamics.<br /><br />The study found that BAE outcomes included a 25% mortality rate and cases of respiratory failure predominantly in patients with compromised lung function. Consequently, the authors suggest that for individuals with severe CF, BAE's risks may outweigh its benefits, advocating for expedited lung transplantation evaluation and efforts to preserve bronchial circulation wherever possible.<br /><br />Supporting this viewpoint, the International Society for Heart and Lung Transplantation recommends considering a lung transplant for CF patients who endure life-threatening hemoptysis despite BAE efforts. The document concludes with an erratum noting the correction of authorship in a related publication and emphasizes the increased hazard of BAE in end-stage CF, urging careful consideration and strategic approach in patient management.

Keywords

bronchial arterial embolization

cystic fibrosis

hemoptysis

respiratory failure

lung transplantation

angiogenesis

bronchial circulation

mortality rate

pulmonary infarction

spinal artery embolization