Bronchial Artery Embolization as a Bridge to Lung Transplantation
Hemoptysis is a common complication in cystic fibrosis (CF), affecting approximately 8% of patients. Massive hemoptysis occurs in 4% of CF patients and accounts for 8.5% of deaths in patients without lung transplantation. Bronchial artery embolization (BAE) is a life-saving intervention in patients with airway compromise or hemodynamic instability from hemoptysis. Despite the effectiveness of BAE in controlling hemoptysis acutely, CF patients who undergo BAE remain at increased risk for recurrent hemoptysis and death; therefore, evaluation for lung transplantation should be considered.
Histopathology of an explanted CF lung after successful bilateral lung transplantation is shown in the attached Image A. Foreign embolic material from prior BAE is identifiable. Image B and Image C highlight the dramatic improvement in CT chest imaging following lung transplantation, illustrating that although BAE is a temporizing procedure, transplantation is the definitive treatment for recurrent, massive hemoptysis in advanced CF lung disease.
Cystic fibrosis, Bronchial artery embolization, Lung transplantation, Massive hemoptysis
Anju Singhal, MD, Advanced Lung Disease Fellow, Inova Advanced Lung Disease and Transplant Program, 3300 Gallows Road, Falls Church, VA 22042, USA.
© 2021 Singhal A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.