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. However, because bae does not address the underlying disease, recurrence of hemoptysis is common and requires frequent repeat embolization 3. Bronchial artery embolization how is bronchial artery. Bronchial artery embolization in hemoptysis 309 table 1. In two patients, single gianturco steelcoil emboli were placed in the proximal bronchial artery after gelatin embolization in an attempt to provide more complete and permanent occlusion. Patients complaining of back pain or weakness following this procedure should have a comprehensive neurologic exam for early diagnosis and management. This case illustrates anterior spinal artery infarction, an uncommon but serious complication following bronchial artery embolization. Bronchial artery embolization for the treatment of acute. Bronchial artery embolisation treatment in hyderabad. 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. Bronchial artery angiography with embolization has become a mainstay in the treatment of 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. Chest radiograph, computed tomography, and bronchoscopy play a complementary role in diagnosing the underlying cause of.
In order to see the bronchial arteries a special dye is. Because mortality due to massive hemoptysis in both benign and malignant disease is high, therapeutic bronchial artery embolization is the preferable approach in some cases. Bronchial artery embolization is an effective and widely used procedure for controlling hemoptysis. Bronchial artery embolization is an important treatment for significant hemoptysis. Bronchial artery embolization is a procedure that is used to treat people who are coughing up blood, also known as haemoptysis. Bronchial artery embolization is an important treatment for significant hemoptysis, given its high early success rate and relatively low risk compared with alternative medical and surgical treatments. Bronchial and nonbronchial systemic artery embolization in. Major complications are rare and immediate clinical success defined as cessation of hemorrhage. One hundred and four patients presenting with either massive or repeated hemoptysis were treated by embolization of the bronchial arteries with a resorbable material spongel. After bronchial artery embolization with several microcoils, selective bronchial arteriogram showed the disappearance of the distal end of the bronchial artery but the initial part presented aneurismal dilatation. Indications, techniques and complications poster no c1176. One hundred and one patients aged 3489 years received bronchial artery embolization with polyvinyl alcohol particles and gelatin sponge for massive or continuing moderate hemoptysis caused by benign pulmonary diseases and resistant to medical treatment. Pathologic processes that affect the airways and pulmonary parenchyma are the most common underlying etiologies that result in hemoptysis.
Detection of arteriographynegative anterior spinal artery. Dieulafoys disease is a vascular anomaly characterized by the presence of a tortuous dysplastic artery in the submucosa. Embolization of an anterior spinal artery is a rare complication that can occur during bronchial artery embolization, typically performed for massive hemoptysis. Blood vessels veins and arteries do not show up on a normal chest xray. To locate the bleeding site, one must be aware of the bronchial artery anatomy, which was well described in 1965 by viamonte et al. Bronchial artery embolization for lifethreatening hemoptysis using trisacryl microspheres. Bronchial artery embolization is an effective alternative to surgery for controlling hemoptysis, with high success rate. Bronchial arterial aneurysm radiology reference article. Spinal cord ischemia is an important complication of bronchial artery embolization for hemoptysis. By searching the 19851999 radiology database, the authors identified 23 young patients who had been referred to the radiology department for angiography. Pdf haemoptysis and bronchial artery embolization in. Supraselective bronchial artery embolization in patients with. Bronchial artery embolization for massive hemoptysis. For the patients who underwent repeat bae, the causes of recurrence based on angiographic findings were categorized.
Although frequently occurring in the gastrointestinal tract, multiple cases of dieulafoys disease in the bronchus have been reported in the literature. They interconnect within the lung with branches of the pulmonary arteries and veins. A branch of the right internal mammary artery was noted to overlie the right upper lobe, and a right bronchial artery was demonstrated. We report two cases of cerebral infarct complicating bronchial artery embolization, most likely due to errant embolic passage through anastomoses with the. Radial artery access to bronchial artery embolization for massive hemoptysis. Here, we are presenting our experience of bronchial artery embolization in 11 patients presented in outpatient department with massive hemoptysis.
Bronchial artery embolization was introduced by remy et al. We report the first case of temporary unilateral diaphragmatic paralysis associated to lung consolidation following bae in a. Transcatheter embolization of bronchial and pulmonary arteries. We performed transcatheter arterial embolization tae using platinum coils. Massive hemoptysis is a serious complication in cystic fibrosis cf, occurring commonly in older patients. Using a 5f visceral selective catheter cook medical inc. Bronchial artery embolization for severe hemoptysis in cystic. Bronchial artery embolization is an established nonsurgical treatment in the management of massive and recurrent hemoptysis 24. To evaluate the efficacy of bronchial arteriography and bronchial artery embolization bae in the management of massive hemoptysis in a developing asian country. Bronchial artery embolization is an effective intervention for treatment of hemoptysis with various underlying etiologies. Massive hemoptysis is a potentially fatal respiratory emergency. However, in most cases, bae was performed via the access of femoral artery. Percutaneous embolization for ruptured ectopic bronchial. After inserting 5f guide catheter into target bronchial artery and injecting contrast medium evaluation of bleeding site was available.
Many authors have demonstrated the use of bronchial artery embolization for control of hemoptysis. Dec 23, 2015 bronchial artery embolization is not indicated in the uncommon case in which hemoptysis arises from a nonbronchial source systemic collateral artery or pulmonary artery. Kalva, md massive hemoptysis is a lifethreatening emergency. We could show a 67yearold man with repeated hemoptysis.
Anterior spinal cord infarction following bronchial artery. The arterial access is gained through a femoral most often or brachial approach. Bronchial artery embolization for the treatment of acute hemoptysis. Bronchial artery embolization for severe hemoptysis in. Prior to the development of this procedure, patients with massive hemoptysis were managed conservatively, or underwent emergency surgery 5, 6. The most common underlying etiologies include tuberculosis, bronchiectasis, aspergillosis, and cystic fibrosis. Bronchial artery embolization possesses high rates of immediate clinical success coupled with low complication rates. The single right bronchial artery usually arises from one of the following. The lesions were mainly located in the right bronchus 53 cases. Bronchial artery embolization in patients presenting with.
Radial artery access to bronchial artery embolization. Bronchial artery embolization for hemoptysis in young. We have controlled massive hemoptysis in five cases with use of our improved techniques and bronchial artery embolization. In two patients, single gianturco steelcoil emboli were placed in the proximal bronchial artery after gelatin embolization in an attempt to. Mar 02, 2014 bronchial artery embolisation in haemoptysis dr. Supraselective bronchial artery embolization in patients. The use of absolute alcohol injections in the bronchial arteries as treatment for hemoptysis has been described. Jun 17, 2016 bronchial artery embolization was first reported in 1973 by remy et al. The left bronchial arteries superior and inferior usually arise directly from the thoracic aorta. Pdf transarterial microcatheter glue embolization of the. Bronchial arterial aneurysm refers to any form of aneurysmal dilatation involving any segment of the bronchial artery.
Haemoptysis and bronchial artery embolization in children. Bae is generally safe and effective, but can sometimes lead to serious complications. Some physicians prefer to obtain a thoracic aortogram before selective bronchial artery angiography. Pdf bronchial artery embolization in the treatment of. The term is sometimes used synonymously with a bronchial arterial pseudoaneurysm 2. Bronchial artery embolization for moderate to massive. Bronchial artery embolization serves as both firstline therapy for massive hemoptysis, and as a bridge to more definitive therapies targeted to the underlying etiology. The bronchial arteriography showed that more right intercostal arteries combining with bronchial artery than left. No bronchial artery embolization should be undertaken without the orientation of previous studies, otherwise treatment will be more difficult 8, 9. Bronchial artery embolization minimally invasive alternative to surgery.
Here, we are presenting our experience of bronchial artery embolization in 11 patients presented in outpatient department with. Bronchial artery embolization for the treatment of hemoptysis. Bronchial artery embolization dr tinku joseph dm resident department of pulmonary medicine aims, kochin email. Bronchial artery aneurysm journal of vascular surgery. Pdf bronchial artery embolization for lifethreatening. Bronchial artery embolization bae is a minimally invasive imageguided intervention used in the management of massive hemoptysis or of a major hemorrhagic hemoptysis event.
Multislice computed tomographic angiography for the study of bronchial arteries 1214 angiotomography with 16detector multislice equipment has proved to be. Abhilash sandhyala, providing the bronchial artery embolisation treatment in hyderabad with ease. Bronchial artery embolization bae, first described by remy et al in 1973, 1 is now considered a firstline treatment for most cases of massive hemoptysis. Pdf outcomes of bronchial artery embolization for life. It is a safe and effective nonsurgical therapeutic option for patients with massive hemoptysis. Bronchial artery bleeding is the most common cause of lifethreatening hemoptysis. The postoperative angiogram after embolization showed no residual arterial flow, and the procedure was. Recent literature supports the use of bronchial artery embolization for hemoptysis in cystic fibrosis 4, 7, 1012. Embolization of this important blood supply to the anterior spinal cord can result in infarction and paralysis. Temporal patterns in severe hemoptysis requiring bronchial. 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. However, malignancyrelated hemoptysis from primary or metastatic lung cancer has received less attention in the bae literature than other benign, more common causes of hemoptysis. Technique, immediate efficacy, recurrence rate, and complications of bronchial artery embolization immediate clinical major hemoptysis clinical success recurrence rate complication rate levels of year author n grade embolizing agent % c%a %b evidence.
Bronchial artery embolization bae has become a wellestablished treatment option in the management of lifethreatening hemoptysis 616. Massive hemoptysis is a potentially life threatening respiratory. Bronchial artery embolization is commonly used to treat massive hemoptysis. The arterial supply was mainly provided by bronchial arteries 48 cases and the pulmonary circulation 4 cases. Bronchial artery embolization to control hemoptysis woo et al decision between the emergency physician, interventional radiologist, pulmonologist, and thoracic surgeon.
Bronchial artery embolization bae is a procedure first described in the early 1970s for the treatment of massive hemoptysis and has since been demonstrated to be safe and effective 2,3. Bronchial artery embolization bae has been accepted as the most effective minimally invasive therapy alternative to surgery for massive and recurrent hemoptysis 1, 2. Posterior circulation stroke after bronchial artery embolization. Transcatheter embolization of bronchial and pulmonary. Bronchial artery embolization to control hemoptysis. Unilateral temporary diaphragmatic paralysis secondary to. The role of multislice computed angiography of the. A bronchial artery embolisation bae is a procedure where xrays are used to examine the bronchial arteries arteries in your lung. Most commonly, these patients suffer from diffuse interstitial lung disease or chronic granulomatous disease such as cystic fibrosis, interstitial pulmonary fibrosis, bronchiectasis. Embolization is more difficult in these cases and there is an increased risk of complications. A bronchialartery embolisation bae is a procedure where xrays are used to examine the bronchial arteries arteries in your lung.
Bronchial artery embolization bae was first described in 1974 to control massive hemoptysis in the nonsurgical patient. Case report mediastinal bronchial artery aneurysm treated. The transradial approach tra is becoming more popular than the transfemoral approach tfa in percutaneous coronary intervention. All cases were followed up for 12 months, and there was no recurrence of bleeding. In such situation, the patient may need surgical treatment. If there is concern that nontarget embolization may occur, especially to the spinal cord, leading to permanent neurologic deficit, embolization should be deferred. In 90% of the cases of massive hemoptysis, the culprit vascular bed is the bronchial circulation rather than the pulmonary 5% or nonbronchial systemic circulations 5% 1,2,3. Oxford centre for respiratory medicine bronchialartery. Bronchial artery embolization bae can be performed to stop the bleeding. Cerebral infarct after bronchial artery embolization. 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. Bronchial artery anatomy is variable, most commonly classified according to cauldwell classification.
In cases of hemorrhage when the cause is not easily identified, or in cases of recurrence in spite of accurate embolization of pathological arteries, the presence of bronchial arteries of anomalous origin should be considered. Thereafter, no restriction of any activities was imposed by the procedure. Following embolization, normal activities, including chest physio therapy, were reinstituted within 24 to 48 hours. Repeat embolization was needed in eight patients to achieve or maintain effective hemostasis. This allows the doctor to find the bronchial artery which is bleeding and causing your haemoptysis coughing up of blood. A classic pattern of two left and a one right main bronchial arteries is found in 70% of patients. In some patients, the bronchial artery or the bleeding artery may not be successfully catheterized, due to its unusual location or it is very tortuous. Bronchial artery embolization is an effective tool for the evaluation and treatment of massive idiopathic hemoptysis. Selective bronchial artery embolization bae was attempted in 38 patients and 20 patients underwent lobectomies. Bronchial artery embolization for malignant hemoptysis. It has been reported even though a spinal artery was not visualized on arteriography. Bronchial artery embolization bae is commonly applied to treat massive hemoptysis. Pdf posterior circulation stroke after bronchial artery.
Embolization for hemoptysisangiographic anatomy of. Background bronchial artery embolization bae is an important treatment option for shortterm control of hemoptysis in patients with simple aspergilloma sa. Transfemoral access with seldingers technique provided route to position guide catheter in thoracic aorta at the level of fifth to sixth thoracic vertebrae. Bronchial artery embolization for treatment of life. In may 2012, we first used a new liquid embolic agent onyx for bronchial artery embolization in treatment of refractory massive hemoptysis in one patient in china and obtained good outcomes. 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. Any information contained in this pdf file is automatically generated from digital material. This article is from iranian red crescent medical journal, volume 15. Bronchial artery embolization as a treatment of hemoptysis.
Bae is a useful therapy to control both acute and chronic hemoptysis. Paralysis following bronchial artery embolization shm abstracts. This paper describes the temporal pattern of severe hemoptysis which required bronchial artery embolization. Cerebral infarct after bronchial artery embolization is a rare and severe complication. Bronchial artery embolization bae has become an established procedure in the management of massive and recurrent hemoptysis. Major complications are rare and immediate clinical success defined as cessation of hemorrhage ranges in most series from 85% to 100%, although recurrence of hemorrhage ranges from 10% to 33%. Bronchial arteriography further demonstrated a ruptured mediastinal baa of a bronchial artery originated from the left subclavian artery, supplying the right lobe. Massive hemoptysis is a severe, lifethreatening illness. Femoral arterial puncture was the commonest approach. Considered to be the most effective nonsurgical treatment in the management of massive and recurrent hemoptysis. Because the primary concern for death in patients with massive hemoptysis occurs secondary to limitation of oxygen transfer, emergent versus urgent intervention should be considered at the earliest signs of hypoxemia andor instability of vital signs, particularly in patients with limited pulmonary reserve.
Herein we describe our experience with 54 patients who underwent bronchial arteriography and bronchial artery embolization bae at mayo clinic through 2000. We report a case of a 15yearold boy suffering recurrent massive hemoptysis. Case report mediastinal bronchial artery aneurysm treated with aortic stent and embolization. Embolization of bronchial arteries of anomalous origin. Detection of the origins and the sources of the abnormal bronchial as well as nonbronchial arteries, before systemic therapeutic embolization, is. Bronchial artery embolization was described as early as 1974 8 and the technique of embolization has not changed significantly since then. Although advances in embolic materials and embolization techniques. Bronchial artery embolization bae involves selective bronchial artery catheterization and angiography, followed by embolization of any identified abnormal vessels to stop the bleeding. Bronchial artery embolization to control hemoptysis in cystic. Bronchial artery embolization bae is considered the most effective nonsurgical emergent treatment for massive hemoptysis, which holds 50%100% mortality rate if treated conservatively.