While the reported rate of paraparesis or paraplegia is 0. Bronchial artery angiography with embolization has become a mainstay in the treatment of hemoptysis. Bronchial artery embolization via percutaneous catheter, in conjunction with medical management antibiotics, with vitamin k and blood transfusions as required, has been the treatment of choice at our institution for lifethreatening hemoptysis in patients with cf for the past ten years. Bronchial artery embolization for severe hemoptysis in. Massive hemoptysis is a serious complication in cystic fibrosis cf, occurring commonly in older patients. Transfemoral access with seldingers technique provided route to position guide catheter in thoracic aorta at the level of fifth to sixth thoracic vertebrae. For treatment of hemoptysis, bronchial artery embolization is a safe and.
A 28yearold man with a known history of malignant melanoma in the neck from 6 years ago and lung metastasis from 1 year ago referred to the emergency department of our teaching hospital with the chief complaint of hemoptysis. We highlight the anatomy and function of the bronchial arteries, typical imaging findings, how to recognize bronchial artery. Anatomy of bronchial arteries the anatomy of the bronchial arteries is quite variable in terms of origin and number. In recent years, the technique of tbae has joined the armamentarium of managing methods for massive hemoptysis. Bronchial artery embolization for malignant hemoptysis. Hemoptysis, arterial embolization, interventional vascular radiology 1. Also note a right bronchial artery arrow arising from the left. Bronchial artery embolization for the treatment of acute. Pdf bronchial artery angiography with embolization has become a mainstay in the treatment of hemoptysis.
To test the efficacy of bronchial artery embolization bae to treat haemoptysis in pulmonary hypertension ph. The transradial approach tra is becoming more popular than the transfemoral approach tfa in percutaneous coronary intervention. Bronchial artery embolization in patients presenting with massive. The bronchial arteriography showed that more right intercostal arteries combining with bronchial artery than left. We evaluated the demographics, clinical presentation, radiographic studies, short and longterm efficacy, and complications in patients who underwent bae, at a tertiary university hospital, from 2003 to 2012.
To illustrate the potential role of transcatheter bronchial artery embolization tbae in the multimodality management of massive hemoptysis, we describe a case in which tbae was successfully employed as the definitive therapy. Radial artery access to bronchial artery embolization for massive hemoptysis. Bronchial artery embolisation in management of hemoptysis core. Most commonly, these patients suffer from diffuse interstitial lung disease or chronic granulomatous disease such as cystic fibrosis, interstitial pulmonary fibrosis, bronchiectasis, tuberculosis, and fungal infections such as. Considered to be the most effective nonsurgical treatment in the management of massive and recurrent hemoptysis. Usually, a spinal artery can originate from a bronchial artery in up to 5% of patients, with right side being more common than the left side. Bronchial artery embolization in management of hemoptysis.
We report two cases of cerebral infarct complicating bronchial artery embolization, most likely due to errant embolic passage through anastomoses with the ipsilateral subclavian artery. Bronchial artery embolization the annals of thoracic surgery. The bronchial arteries are the major supply of highpressure oxygenated blood to the supporting structures of the lung, including the pulmonary arteries, yet they are responsible for only 1% of the lung blood flow overall bronchial artery anatomy is variable, most commonly classified according to cauldwell classification a classic pattern of two left and a one right main bronchial arteries. Request pdf bronchial artery embolization hemoptysis represents a significant clinical entity with high morbidity and potential mortality. Unilateral temporary diaphragmatic paralysis secondary to. Systemic multifocal infarction following bronchial artery.
Bronchial artery embolisation bae becomes a mainstay in the treatment of hemoptysis. Bronchial artery embolization for massive hemoptysis jama network. This complication is attributed to inadvertent embolization of the spinal artery which originates from a bronchial artery in 5% of patients. Role of bronchial artery embolization in the management of. Outcome and safety measures were documented according to society of interventional radiology sir practice guidelines. We have controlled massive hemoptysis in five cases with use of our improved techniques and bronchial artery embolization. A 37yearold man, who was otherwise healthy, presented with chest discomfort and was found to have a large right bronchial artery aneurysm. Bronchial artery embolization remains the primary and most effective method in controlling massive hemoptysis. Systemic multifocal infarction following bronchial artery embolization with microsphere particles. Supraselective bronchial artery embolization in patients. Transcatheter embolization of bronchial arteries in the. An irbapproved retrospective study at our academic institution was conducted on all patients treated by bae for hemoptysis from lung malignancy. If there is concern that nontarget embolization may occur, especially to the spinal cord, leading to permanent neurologic deficit, embolization should be deferred.
A 70yearold female was admitted to our hospital after being diagnosed with lung cancer of the left upper lobe and right bronchial artery aneurysm baa identified by computed tomographic angiography cta. A tuberculous bronchial artery aneurysm with abnormal. We aimed to report our experience with bronchial artery embolization bae in the management of moderate recurrent andor lifethreatening hemoptysis. Bronchial artery embolization is an important treatment for significant hemoptysis, given its high early success rate and. Prior to the development of this procedure, patients with massive hemoptysis were managed conservatively, or underwent emergency surgery 5, 6. Cerebral infarct after bronchial artery embolization is a rare and possibly fatal complication. Despite two attempts at embolization, the aneurysm continued to have persistent flow.
Reninassociated hypertension after bronchial artery. Bronchial artery embolization is an effective intervention for treatment of hemoptysis with various underlying etiologies. Nontarget embolization of branches of subclavian artery causing injury to other organs. However, in most cases, bae was performed via the access of femoral artery.
Diagnostical value of simultaneous arteriography of the pulmonary artery and bronchial arteries in bronchial carcinoma. Bronchial artery embolization bae is considered the most effective nonsurgical emergent treatment for massive hemoptysis, which holds 50%100% mortality rate if treated conservatively. Bronchial artery embolization as a treatment of hemoptysis. Radial artery access to bronchial artery embolization. Bronchial and nonbronchial systemic artery embolization in. Bronchial and nonbronchial systemic arteries are the main source of bleeding and are embolized with polyvinyl alcohol particles or gelatin sponge. Bronchial artery aneurysm refractory to transcatheter. Because the bleeding recurrence rate is high in patients with lung cancer or idiopathic bronchiectasis, surgery should be considered in these patients following initial stabilization by bronchial artery embolization. Wed like to understand how you use our websites in order to improve them. Bronchial artery embolization bae can be performed to stop the bleeding. The postoperative angiogram after embolization showed no residual arterial flow, and the procedure was.
Bronchial artery embolization bae is a safe and effective treatment for massive hemoptysis, as well as for chronic but non massive hemoptysis that impairs a patients quality of life or can be a precursor of a massive hemoptysis6, 7. Particles may flow across the abnormal communication between bronchial artery and pulmonary artery, causing obstruction of the small pulmonary artery. Massive hemoptysis is a potentially life threatening respiratory. Bronchial artery embolization is an effective immediate treatment for massive hemoptysis. The left bronchial arteries superior and inferior usually arise directly from the thoracic aorta the single right bronchial artery usually arises from one of the following. The pulmonary lung procedures our doctors can perform fall under one of these categories. Bronchial artery embolization is the recommended therapy for massive hemoptysis in patients with cystic fibrosis cf. The predominant proposed pathway is from unintentional embolization of the occipital cortex in the setting of fistula formation arising from the bronchial artery to either the pulmonary veins or the vertebral arterial distribution. Bae is generally safe and effective, but can sometimes lead to serious complications.
Efficacy and safety of bronchial artery embolization on. Management of massive hemoptysis by bronchial artery. Massive hemoptysis has high mortality even after surgical treatment. Bronchial artery embolization for hemoptysis article pdf available in seminars in interventional radiology 281. He complained of moderate hemoptysis for 20 years prebae with recurrent expectoration of yellowish and greenish sputum and dyspnoea fig. Bronchial artery embolization in patients presenting with. Bronchial artery embolization bae has become an established procedure in the management of massive and recurrent hemoptysis. Bronchial artery embolization for the treatment of. In our hospitalbased crosssectional study, 11 patients had undergone procedure for bronchial artery embolization in the department of interventional radiology tifaccore. Embolization procedures represent the firstline treatment for hemoptysis arising from a bronchial arterial source. Knowledge of bronchial and nonbronchial systemic circulation is mandatory to reduce complications and to increase technical success. The distribution and frequency of embolization of the arteries were agreed with kwon et al. Article information, pdf download for bronchial artery embolization.
Bronchial artery embolization for hemoptysis in cystic fibrosis. Pathology and pathogenesis of pulmonary arterial aneurysm in tuberculous cavities. Bronchial artery embolization is an effective way to control massive hemoptysis with a low recurrence rate and reduced mortality among severely ill patients. The details of procedure, outcome, and rate of relapse were compared between the two groups. In these patients, bronchial artery embolization may be effective in the control of acute bleeding, but permanent control of hemoptysis is achieved only by later surgery. Cerebral infarct after bronchial artery embolization is a rare and severe complication. To assess the effectiveness of bronchial artery embolization bae in patients with malignant hemoptysis. Massive hemoptysis is a potentially fatal respiratory emergency. Bronchial artery embolization for hemoptysis article pdf available in seminars in interventional radiology 253. Pdf bronchial artery embolization for hemoptysis researchgate.
This paper describes the temporal pattern of severe hemoptysis which required bronchial artery embolization. Bronchial artery embolization for management of massive. This article is from iranian red crescent medical journal, volume 15. Bronchial artery embolization minimally invasive alternative to surgery. Hemoptysis requiring bronchial artery embolization in. Here, we are presenting our experience of bronchial artery embolization in 11 patients presented in outpatient department with massive hemoptysis. Bronchial artery embolization bae is commonly applied to treat massive hemoptysis. This may result in stroke, finger ischemia or even death. Between patients with and without hemoptysis, there were no significant differences with respect to sex, radiographic manifestations, distribution over 3 lobes on chest computed tomography, history of pulmonary tuberculosis.
We performed transcatheter arterial embolization tae using platinum coils. Cerebral infarct after bronchial artery embolization bjr. Anastomotic communications may exist between the bronchial artery and intercostal arteries, that in turn, may communicate with the subclavian artery and so, embolic material may pass to the vertebral artery. Bronchial artery embolization for the treatment of acute hemoptysis. Bronchial artery embolization bae was first described in 1974 to control massive hemoptysis in the nonsurgical patient. These complications were presumably related to crossing of small calibrated microspheres through arteriovenous. Series of 11 patients with the clinical picture of massive haemoptysis was referred to our hospital for digital subtraction angiography and bae within a 33 months period. Temporal patterns in severe hemoptysis requiring bronchial. The embolic material for bae has typically included polyvinyl alcohol pva particles and gelatin sponge particles. Bronchial artery embolization is highly effective in the treatment of acute hemoptysis. Management of lifethreatening hemoptysis journal of.
Bronchial artery embolization for moderate to massive. Major complications are rare and immediate clinical. Transcatheter bronchial artery embolization in the. Pdf bronchial artery bleeding is the most common cause of lifethreatening hemoptysis. We report the first case of temporary unilateral diaphragmatic paralysis associated to lung consolidation following bae in a. Recent literature supports the use of bronchial artery embolization for hemoptysis in cystic fibrosis 4, 7, 1012. Shortterm non recurrence rates with followup up to 1 month range from 77% to 99%.
The enlargement of the bronchial arteries occurs in a multitude of congenital and acquired diseases and is responsible for the majority of cases of hemoptysis. Bronchial artery embolization is an effective alternative to surgery for controlling hemoptysis, with high success rate. Bronchial artery embolization for massive hemoptysis. Bronchial artery aneurysm journal of vascular surgery. Bronchial artery embolization is not indicated in the uncommon case in which hemoptysis arises from a nonbronchial source systemic collateral artery or pulmonary artery. Therapeutic bronchial artery embolization is a good treatment adjunct to control bronchial bleeding and reduces the need for highrisk emergency lung resections. We report on two cases of multiple renal infarcts and reninassociated hypertension and hypokalemia occurring in cf adults after bronchial artery embolizations. Still today bronchial artery embolization bae is an important procedure in the management of hemoptysis, as an alternative to, or in association with, surgical or medical therapy. C completion angiogram through the base catheter shows stasis of contrast. Bronchial artery embolization bae is the minimally invasive alternative considered the most effective nonsurgical treatment of patients with massive or recurrent hemoptysis 1, 2. While massive hemoptysis has traditionally been defined. Bronchial artery aneurysms occur rarely, but they are potentially life threatening and require treatment to avoid rupture and other complications.397 263 690 607 1614 1612 1189 1015 466 1145 1289 858 926 498 363 395 1594 991 167 991 1249 699 76 1586 1038 736 1102 1376 1296 215 908 897