Kenichi Okuda1, Kimihiko Masuda2, Masahiro Kawashima3, Takahiro Ando4, Kazuya Koyama5, Nobuharu Ohshima6, Atsuhisa Tamura7, Hideaki Nagai8, Shinobu Akagawa9, Hirotoshi Matsui10, Ken Ohta11. 1. Center for Respiratory diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan. Electronic address: rgjyc340@ybb.ne.jp. 2. Center for Respiratory diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan. Electronic address: kimihiko-in@tokyo-hosp.jp. 3. Center for Respiratory diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan. Electronic address: mkawashima-in@tokyo-hosp.jp. 4. Center for Respiratory diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan. Electronic address: takaandou-tky@umin.ac.jp. 5. Center for Respiratory diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan. Electronic address: d.er.leier@hotmail.co.jp. 6. Center for Asthma and Allergy, National Hospital Organization Tokyo National Hospital, Tokyo, Japan. Electronic address: ohshima-in@tokyo-hosp.jp. 7. Center for Respiratory diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan. Electronic address: tamura-in@tokyo-hosp.jp. 8. Center for Respiratory diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan. Electronic address: hnagai-in@tokyo-hosp.jp. 9. Center for Respiratory diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan. Electronic address: bob-in@tokyo-hosp.jp. 10. Center for Respiratory diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan. Electronic address: hmatui-in@tokyo-hosp.jp. 11. Center for Respiratory diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan; Center for Asthma and Allergy, National Hospital Organization Tokyo National Hospital, Tokyo, Japan. Electronic address: kenohta@tokyo-hosp.jp.
Abstract
BACKGROUND: Hemoptysis frequently develops in patients with Mycobacterium avium complex (MAC) pulmonary disease. Bronchial artery embolization (BAE) has been established as one of the useful treatments of massive and persistent hemoptysis. We evaluated the efficacy and safety of BAE for controlling hemoptysis in MAC patients, and identified the risk factors of rebleeding after BAE. METHODS: Among the 529 patients with MAC who were admitted to our institution from January 2007 to December 2012, we retrospectively reviewed the demographic data, imaging, sputum, and angiographic findings, and the clinical course of 43 patients who underwent BAE using coils, due to hemoptysis. RESULTS: Among the 43 patients enrolled in the study, rebleeding developed in 13 cases (30.2%) with a mean follow-up period of 18 months. Median rebleeding-free time after BAE was 29.9 months and the cumulative hemoptysis control rates were 79.1%, 73.8%, and 63.3% in one, two, and three years, respectively. Rebleeding-free time significantly correlated with comorbid chronic pulmonary aspergillosis (CPA). When limited to 35 MAC patients without CPA, the rate increased to 88.6%, 82.1%, and 70.4%, respectively. Factors such as coexisting CPA, multiple embolized vessels at BAE, longer length of time from the diagnosis of MAC to BAE, and an administration of antibiotics for MAC at the time of hemoptysis, indicated statistically significant correlations with rebleeding. Major complications concerning BAE were not encountered. CONCLUSIONS: BAE using coils is an effective and safe method for controlling hemoptysis in patients with MAC pulmonary disease. However, it is important to carefully observe patients with risk factors for rebleeding after BAE.
BACKGROUND: Hemoptysis frequently develops in patients with Mycobacterium avium complex (MAC) pulmonary disease. Bronchial artery embolization (BAE) has been established as one of the useful treatments of massive and persistent hemoptysis. We evaluated the efficacy and safety of BAE for controlling hemoptysis in MACpatients, and identified the risk factors of rebleeding after BAE. METHODS: Among the 529 patients with MAC who were admitted to our institution from January 2007 to December 2012, we retrospectively reviewed the demographic data, imaging, sputum, and angiographic findings, and the clinical course of 43 patients who underwent BAE using coils, due to hemoptysis. RESULTS: Among the 43 patients enrolled in the study, rebleeding developed in 13 cases (30.2%) with a mean follow-up period of 18 months. Median rebleeding-free time after BAE was 29.9 months and the cumulative hemoptysis control rates were 79.1%, 73.8%, and 63.3% in one, two, and three years, respectively. Rebleeding-free time significantly correlated with comorbid chronic pulmonary aspergillosis (CPA). When limited to 35 MACpatients without CPA, the rate increased to 88.6%, 82.1%, and 70.4%, respectively. Factors such as coexisting CPA, multiple embolized vessels at BAE, longer length of time from the diagnosis of MAC to BAE, and an administration of antibiotics for MAC at the time of hemoptysis, indicated statistically significant correlations with rebleeding. Major complications concerning BAE were not encountered. CONCLUSIONS:BAE using coils is an effective and safe method for controlling hemoptysis in patients with MACpulmonary disease. However, it is important to carefully observe patients with risk factors for rebleeding after BAE.