Bronchial Artery Embolization to Control Hemoptysis: Comparison of N-Butyl 2-Cyanoacrylate and Polyvinyl Alcohol Particles

Abstract

Introduction: The purpose of this was study was to retrospectively compare the safety and effectiveness of two embolic agents (polyvinyl alcohol [PVA] particles vs. n-butyl 2-cyanoacrylate [NBCA]) for bronchial artery embolization (BAE) for control of hemoptysis.

Methods: Institutional Review Board approved this retrospective study

informed consent was waived. From January 2005 to December 2008, 406 patients (M:F = 242:164

6-92 years) with major hemoptysis underwent BAE using PVA particles (n = 293) or NBCA (n = 113). Technical and clinical success, complications, hemoptysis-free survival rates, the causes of recurrent hemoptysis were compared between PVA and NBCA groups. The differences in hemoptysis-free survival rates were also assessed between subgroups stratified to underlying diseases. The predictive factor for recurrent hemoptysis was identified with Cox proportional hazards regression model.

Results: Technical success was achieved in 93.9% (275 of 293) and 96.5% (109 of 113) of patients for PVA and NBCA, respectively (P = .463)

clinical success was achieved in 92.2% (270 of 293) and 96.5% (109 of 113) of patients for PVA and NBCA, respectively (P = .180). The 1-, 3-, and 5-year hemoptysis-free survival rates were, respectively, 77%, 68%, and 66% for PVA and 88%, 85%, and 83% for NBCA (P = .010). Recanalization of previously embolized vessels was more frequent in the PVA group (21.5%) than in the NBCA group (1.8%

P < .001). The NBCA group showed hemoptysis-free survival rates superior to the PVA group in patients with bronchiectasis (P = .016). The use of PVA (P = .050) and aspergilloma (P < .001) were predictive factors for recurrent hemoptysis.

Conclusions: BAE with NBCA provided higher hemoptysis-free survival rates compared with PVA particles without increasing complication rates. This improvement was evident in patients with bronchiectasis and seems to be caused by a more durable embolic effect than PVA particles.