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Bronchial Artery Embolization in Pediatric Pulmonary Hemorrhage: A Single-Center Experience
Qu-Ming Zhao1, Lu Zhao1, Lan He1
1Pediatric Heart Center, Children's Hospital of Fudan University, 399 Wanyuan Rd., Minhang, Shanghai 201102, China.
Insights
Bronchial artery embolization (BAE) is a safe and effective treatment for children experiencing pulmonary hemorrhage. This procedure demonstrated high success rates in resolving hemoptysis and improving bleeding-free survival.
Area of Science:
- Interventional Radiology
- Pediatric Pulmonology
- Vascular Medicine
Background:
- Pulmonary hemorrhage in children poses significant clinical challenges.
- Bronchial artery embolization (BAE) is an established treatment for pulmonary hemorrhage in adults.
- Limited data exists on the safety and efficacy of BAE specifically in pediatric populations.
Purpose of the Study:
- To evaluate the safety and effectiveness of bronchial artery embolization (BAE) in pediatric patients with pulmonary hemorrhage.
- To assess the technical and clinical success rates of BAE in this cohort.
- To determine the complication rates and long-term outcomes associated with BAE for pulmonary hemorrhage in children.
Main Methods:
- Retrospective review of 41 pediatric patients who underwent BAE between February 2016 and February 2019.
- Analysis of indications for BAE, including massive hemoptysis, recurrent hemoptysis, and refractory anemia.
- Review of embolization techniques, embolic agents used, and clinical outcomes, including technical success, clinical success, complications, and bleeding-free survival.
Main Results:
- Technical success was achieved in 97.6% of patients, with clinical success in 90.2%.
- The primary etiologies included pulmonary hemosiderosis (58.5%), congenital heart disease (17.1%), and infection (14.6%).
- Low complication rates (2.4% cerebral infarction) and mortality (2.4% multiple-organ dysfunction) were observed, with 36-month bleeding-free survival at 70.8%.
Conclusions:
- Bronchial artery embolization (BAE) is a safe and effective therapeutic option for managing pulmonary hemorrhage in children.
- BAE offers high rates of technical and clinical success with acceptable safety profile in the pediatric population.
- The procedure is associated with favorable long-term bleeding-free survival, supporting its role in pediatric interventional radiology.
Purpose:
To explore the safety and effectiveness of bronchial artery (BA) embolization (BAE) in children with pulmonary hemorrhage.
Materials And Methods:
Between February 2016 and February 2019, 41 patients (median age, 4 y; interquartile range, 2.3-8 y; median weight, 17.6 kg; interquartile range, 12.3-23.6 kg) underwent BAE. The indication of BAE included massive hemoptysis in 10 patients (24.4%), recurrent hemoptysis in 18 patients (43.9%), and refractory anemia in 13 patients (31.7%). The main etiology of pulmonary hemorrhage included pulmonary hemosiderosis (58.5%), congenital heart disease (17.1%), and infection (14.6%). A retrospective review was conducted of clinical outcomes of BAE.
Results:
There were 44 embolization sessions, with a total of 137 embolized vessels. Pulmonary hemorrhage was caused by BAs in 30 cases, nonbronchial systemic arteries plus BAs in 10, and nonbronchial systemic arteries in 1. Embolic particles were used in 30 cases (24 polyvinyl alcohol [PVA] and 6 microsphere), coils in 9 cases, and particles plus coils in 5 cases (4 PVA and 1 microsphere). Technical success (ability to embolize abnormal vessel) was achieved in 97.6% of patients (40 of 41), and clinical success (complete or partial resolution of hemoptysis within 30 days of embolization) was achieved in 90.2% (37 of 41). There was 1 procedure-related complication (2.4%) of cerebral infarction and 1 death from multiple-organ dysfunction (2.4%). Bleeding-free survival rates at 6, 12, 24, and 36 months were 92.5%, 83.9%, 83.9%, and 70.8%, respectively.
Conclusions:
BAE is a safe and effective procedure in children with pulmonary hemorrhage.
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