Bronchial Artery Embolization Research Articles

Bronchial Artery Embolization.

Massive hemoptysis is a highly morbid medical condition with up to 75% mortality with conservative treatment. Bronchial artery embolization has emerged as the common treatment for both acute massive hemoptysis and chronic hemoptysis. This article will review the clinical presentation, bronchial artery anatomy, embolization procedure, complications, and expected outcomes.

Advancements in Interventional Oncology of the Chest: Transarterial Chemoembolization and Related Therapies.

While embolization therapy has been used for many years in the treatment of nonmalignant diseases of the chest, such as pulmonary arteriovenous malformation treatment and bronchial artery embolization for hemorrhage, the application of transarterial techniques to the treatment of chest neoplasms is relatively uncommon. Extrapolating from transarterial chemoembolization techniques used for liver malignancy, investigators have recently sought to expand the indications for transarterial techniques from the control of symptoms such as bleeding to the control of disease progression and potentially survival benefit in patients with malignancies in the chest. This article provides an overview of the current embolotherapy techniques used in the treatment of patients with thoracic malignancies.

Abstract No. 342 Management of hemoptysis with bronchial artery embolization: benign versus malignant disease

Abstract No. 342 Management of hemoptysis with bronchial artery embolization: benign versus malignant disease

Bronchial Artery Embolization for Life-Threatening Hemoptysis in COVID-19 Patients

AbstractAfter the outbreak of the novel coronavirus at the end of December 2019 in China, it has become a global pandemic. Clinical manifestation of coronavirus disease 2019 (COVID-19) has a wide range of presentations from asymptomatic to severe multi-organ involvement. Hemoptysis appears to be one of the major manifestations of severe acute respiratory syndrome that is related to COVID-19 infection. The occurrence of hemoptysis is multifactorial. However, massive hemoptysis is usually related to pulmonary aspergillosis or severe bronchiectasis due to corticosteroid pulse therapy that can be life-threatening. This manuscript presents five cases of successful life-saving bronchial artery embolization in patients with COVID-19 infection who were suffering from massive hemoptysis that was mostly related to aspergillosis and bronchiectasis. These cases are followed by a review of the literature.

Angiographic and histopathological study on bronchial-to-pulmonary vascular anastomoses on explants from patients with cystic fibrosis after bronchial artery embolisation

Labelled backgroundHaemoptysis is a life-threatening complication of cystic fibrosis (CF). One treatment is bronchial artery embolisation (BAE) using embolic-microspheres (EMs). During BAE, pulmonary arteries can be seen on digital subtracted angiography while iodine containing contrast material injection is performed in the bronchial artery. This suggests that EMs could go from bronchial to nontarget pulmonary arteries. The aim was to evaluate if EMs could be found inside pulmonary arteries on lung explants after BAE in transplanted CF patients. MethodsRetrospective observational study including patients with CF who underwent lung transplantation and had previously needed BAE. Clinical, chest CT angiography, and angiographic data were reviewed from medical records. Pathology examination of lung explants was performed to analyze the EMs anatomical localisation. ResultsEight patients were included between 2013 and 2015, four males with a mean age of 29 (19-45) years. All patients had bronchial artery hypertrophy on CT and bronchial-to-pulmonary artery shunting during BAE. On pathology examination, EM ≤800 µm were found in the pulmonary arteries in all patients and were responsible for distal branch occlusions. Two pulmonary infarcts were observed on CT angiography after BAE and confirmed histopathologically. ConclusionsEM migration from the bronchial to pulmonary arteries is a common occurrence after BAE in patients with advanced stage CF. Although BAE is a highly effective means of controlling haemoptysis in CF, studies on the optimal particle size are needed to preserve pulmonary artery circulation, because these results suggest that low size EMs could lead to nontarget embolisation.

Massive Hemoptysis in Post-Tubercular Sequelae

Massive hemoptysis can lead to respiratory failure and life-threatening hypoxia in patients with underlying post-tubercular fibrocavitary disease. In the absence of urgent surgical interventions in a resource-poor country, interventional bronchoscopy and bronchial artery embolization (BAE) can be lifesaving in critical care management of such patients. We present a young male who required mechanical ventilation, emergency bronchoscopic intervention, and BAE, and showed recovery.

Bronchial artery hypertrophy-associated perioperative pulmonary hemorrhage in cardiovascular surgery: a case report

BackgroundPulmonary hemorrhage is a life-threatening complication of cardiovascular surgery. Bronchial artery hypertrophy, a rare pathology associated with inflammatory and ischemic respiratory diseases, increases the risk of pulmonary hemorrhage; however, its involvement in cardiovascular surgery is not well known. We present two cardiovascular surgical cases in which embolization of the hypertrophied bronchial artery was effective in controlling perioperative pulmonary hemorrhage.Case presentationThe first case was a 51-year-old man with chronic obstructive pulmonary disease who developed acute type A aortic dissection. After emergent surgery, his blood pressure suddenly dropped in the intensive care unit; computed tomography revealed a right hemothorax. Because a 4-mm dilated bronchial artery was identified on preoperative computed tomography, the hemothorax was suspected to be associated with bronchial artery hypertrophy. Selective bronchial arteriography was emergently performed and revealed a right pulmonary parenchymal blush. After subsequent coil embolization of the bronchial artery, the parenchymal blush disappeared, and his hemodynamic condition stabilized. The second case was a 66-year-old man with bronchiectasis who was referred for redo aortic valve replacement due to structural valve deterioration. A bioprosthesis was previously implanted to avoid permanent anticoagulation because the patient had repeated episodes of hemoptysis; however, he still had persistent hemosputum during admission for the redo aortic valve replacement. A dilated bronchial artery 3.7 mm in size was incidentally identified on preoperative computed tomography, and hence, the repeated hemosputum was suspected to be associated with bronchial artery hypertrophy. Bronchial arteriography revealed a right pulmonary parenchymal blush, and prophylactic embolization of the bronchial artery was performed. The hemosputum disappeared after the procedure, and redo aortic valve replacement was performed uneventfully 8 days later.ConclusionIn cardiovascular surgery, the risk of pulmonary hemorrhage associated with bronchial artery hypertrophy should be considered, especially in patients with inflammatory and ischemic respiratory diseases.

Bronchial artery embolization for hemoptysis caused by metastatic hepatocellular carcinoma

Because of its extremely rare incidence, the safety and efficacy of bronchial artery embolization (BAE) for the treatment of hemoptysis caused by pulmonary metastasis from HCC are not well known. We therefore evaluated the safety and efficacy of BAE in these patients. Data from 18 patients with hepatocellular carcinoma (HCC) and pulmonary metastasis who received BAE for the treatment of hemoptysis between 2003 and 2021 were retrospectively reviewed. Technical and clinical success were achieved in 100% and 94% of patients, respectively. Of the 18 embolization procedures, six were performed using polyvinyl alcohol (PVA) particles only, five were performed using gelfoam only, three were performed using gelfoam plus microcoils, one was performed using PVA plus microcoils, one was performed using embospheres, one was performed using lipiodol plus PVA and gelfoam, and one was performed using hystoacryl with microballoon protection. In eight patients for whom CT just before BAE and at follow-up were available, the mean size of the largest metastatic tumor decreased from 5.1 to 3.7 cm (P = 0.035). Hemoptysis recurred in three patients (17%) during follow-up. The median overall and hemoptysis-free survival periods were 149 days and 132 days, respectively. BAE is an effective and safe option for the treatment of hemoptysis in patients with pulmonary metastasis from HCC, with a favorable clinical success rate and a low rate of hemoptysis recurrence. In addition, we also observed BAE to have a positive antitumor effect on pulmonary metastases from HCC, but this requires confirmation in a future study.

Late endovascular coil migration following traumatic pulmonary artery pseudoaneurysm embolization: case report

BackgroundPercutaneous vascular interventions are performed for the treatment of haemoptysis and involve embolization of bronchial arteries, pulmonary arteries and pulmonary arteriovenous malformations. There are isolated reports of embolization of pseudoaneurysms forming in the pulmonary vasculature. The migration of components of the coils used in the embolization of vascular pulmonary pathologies is rare.Case presentationA 46-year-old man presented to the emergency department with cough, haemoptysis, and expectoration of lengths of metal wire. He had an episode of coughing out a wire about a year prior to his admission to our hospital, which he attributed to be present in the can of coke he had consumed at that time and did not report it to the doctors. His past medical history was significant for stab injury to the right chest 17 years ago, for which he underwent right thoracotomy and exploration for bleeding. Injury to the lung parenchyma was noted and repair was performed by suturing the defect. Post operatively the CT scan demonstrated development of pulmonary artery pseudoaneurysm. We report a case of a patient expectorating coils 17 years after embolization of this traumatic pulmonary artery pseudoaneurysm. Radiological imaging demonstrated coils in the perihilar area of the lung parenchyma and in the tracheobronchial lumen. Operative intervention was used to remove the coils.ConclusionsAlthough percutaneous catheter based vascular interventions have emerged as safe and effective procedures, the long-term complications such as coil migration, recanalization and need for further embolization ought to be considered and patients need to be counselled and followed-up accordingly. To the best of our knowledge, this is the first case of migrated coil post embolization of post-traumatic pulmonary artery pseudoaneurysm. Ultimately, the management of endobronchial coil migration post embolization, be it surgical or bronchoscopic, should be decided on a case-by-case basis, considering the patient’s symptoms and the risk fatal complications.

Utility of Cone-Beam CT for Bronchial Artery Embolization and Chemoinfusion: A Single-Institution Retrospective Case Series

PurposeTo describe the technique and document utility of adjunctive cone-beam CT (CBCT) in patients undergoing bronchial artery embolization (BAE) or chemoinfusion (BAC).Materials and MethodsBetween August 2010 and February 2021, 26 patients (62 bronchial arteries) were evaluated with CBCT in addition to the usual digital subtraction angiography (DSA) during BAE or BAC. 19 patients (43 arteries) underwent BAE for hemoptysis; 7 patients (19 arteries) had BAC for palliation of lung malignancy. Retrospective review of procedural reports and the archived DSA and CBCT images was assessed for (1) whether CBCT findings added unique diagnostic information prior to treatment of target arteries compared to DSA alone; and (2) whether these unique CBCT findings led to modification of embolization or chemoinfusion technique.ResultsIn 61 of 62 (98%) interrogated bronchial arteries, CBCT provided additional unique diagnostic information over planar DSA, primarily cross-sectional assessment of the spinal canal for spinal arteries. In 46/62 (74%) of the bronchial arteries the unique information did not lead to a change in therapeutic technique. In 15 bronchial arteries (24%), the added information from CBCT led to change in embolization and/or chemoinfusion technique. Embolization of one small unrecognized spinal artery branch (1.6%), which was missed intra-procedurally but retrospectively seen on CBCT led to transient spinal cord ischemia.ConclusionsThese results suggest that adjunctive use of CBCT technique may improve diagnostic confidence from information provided by DSA in nearly all cases of BAE and BAC leading to improved therapeutic targeting or change in technique of embolization or chemoinfusion.

CIRSE Standards of Practice on Bronchial Artery Embolisation

This CIRSE Standards of Practice document is aimed at interventional radiologists and provides best practices for performing bronchial artery embolisation to effectively treat haemoptysis. It has been developed by an expert writing group established by the CIRSE Standards of Practice Committee.

Embolization with more diluted glue-lipiodol in patients with massive hemoptysis: single center experience results.

The aim of the study was to demonstrate the efficacy and safety of bronchial artery embolization (BAE) with more diluted N-butyl-2- cyanoacrylate (NBCA) in patients with massive hemoptysis. In this retrospective study, there are 48 patients who underwent NBCA and BAE for massive hemoptysis between March 2018 and September 2021. Demographic data, technical and clinical results, immediate hemoptysis control, recurrent hemoptysis and complications were evaluated. The technical success rate and immediate hemoptysis control were achieved in 97.9% and 93.7%, respectively. The 3 patients who were exitus within the first 10 days were removed from the follow-up range. During the follow-up period (range, 5 months-42 months; median, 27.5 months), recurrent hemoptysis was found in 3 of the 45 patients (6.6 %). Since 1 patient refused and one patient died within the first 24 hours, repeated BAE procedures were performed in 4 patients. A total of 55 sessions of BAE with NBCA was performed to 48 patients. The underlying diseases causing hemoptysis were determined to be bronchiectasis (n=16), tuberculosis (n=8), neoplasm (n=7), aspergilloma (n=3), and arteriovenous malformation (n=2). In 4 patients, bronchiectasis and tuberculosis were present together and in 8 patients, the cause could not be specified. In conclusion, BAE with more diluted NBCA is a safe and effective embolization method. In addition, the use of more diluted NBCA reduces the recurrence rates in patients with hemoptysis.

Chronic Thromboembolic Pulmonary Hypertension (CTEPH) and massive hemoptysis: The rationale for bronchial artery embolization

IntroductionIn many patients with Chronic Thromboembolic Pulmonary Hypertension (CTEPH), bronchial artery hypertrophy is observed. Patients with bronchial dilatation have been shown to be at increased risk of hemoptysis introducing the risk of airway obstruction. In this study from an academic tertiary referral center, we aimed to assess the incidence of massive hemoptysis in our CTEPH patients, the success of bronchial artery embolization (BAE), recurrence, and hemoptysis-related mortality. MethodsRetrospective cohort study of all adults with CTEPH who underwent BAE for massive hemoptysis between 1 January 2015 and 30 July 2021. Primary endpoints were hemoptysis relapse and hemoptysis-related mortality. ResultsThere were 367 patients who were being treated and managed with a diagnosis of CTEPH at our institution. There were 24 bronchial artery embolization procedures performed for all causes. A total of 3 patients during this time met inclusion criteria with acute massive hemoptysis and CTEPH. All patients were taking therapeutic-dose anticoagulation. Technical success after BAE was 100%. No hemoptysis recurrence was demonstrated at 17, 24, and 40-months follow-up respectively. No patient died from hemoptysis. However, 1 patient died 24 months after the embolization procedure due to a non-hemoptysis cause. ConclusionThis study highlights the low but important incidence of massive hemoptysis in patients with CTEPH. Unlike other causes of hemoptysis, this unique cohort requires balancing anticoagulation and hemorrhage control. Given the high degree of success, BAE is a viable option, allowing continuation or early re-establishment of anticoagulation.

Massive hemoptysis managed by prolonged anticoagulation-free veno-venous extracorporeal membrane oxygenation with which thoracic surgeries were accompanied: a case report

BackgroundMassive hemoptysis causing inadequate ventilation results in life-threatening consequences. We present a patient who developed respiratory insufficiency produced by bronchiectatic massive hemoptysis and underwent prolonged anticoagulation-free veno-venous extracorporeal membrane oxygenation (VV-ECMO) during which thoracic surgeries were performed.Case presentationA 79-year-old woman suffered massive hemoptysis resulting in respiratory failure during fiberoptic bronchoscopy. Bronchial intubation followed by one lung ventilation failed to ensure adequate oxygenation. Anticoagulation-free VV-ECMO, therefore, was installed immediately. Since conservative hemostatic measures including bronchial arterial embolization were not effective, resection of the culprit lung was performed while on VV-ECMO. Next day an exploratory thoracotomy and intercostal artery embolization were needed for recurrent bleeding. The VV-ECMO was withdrawn after five days of operation.ConclusionsMassive hemoptysis can be fatal and needs instantaneous and intensive treatments. In our case, long-term anticoagulation-free VV-ECMO during which thoracic surgeries and endovascular interventions were performed provided a favorable outcome.

Bronchial Arteries Embolization in Tuberculosis-Related Recurrent Hemoptysis with Complete Right Lung Atelectasis: A Case Report

Introduction: Hemoptysis is an emergency condition with high morbidity and mortality which requires immediate treatment. Active tuberculosis (TB) and post-tubercular sequelae can result in hemoptysis with the most common source is from bronchial artery.Case: We reported a 22-year-old man who presented with shortness of breath and recurrent hemoptysis. A chest X-Ray showed total atelectasis right lung due to obstructive airway. After aspiration clotting blood in bronchus and instillation adrenalin with fiber optic bronchoscopy, the atelectasis totally disappeared. Computed tomography angiography (CTA) showed prominent vascular lesions from the apical right pulmonary artery, right brachialis artery, and branch of the posterior intercostal artery. The patient was referred to the interventional unit of the radiology department in Dr. Soetomo General Hospital and underwent bronchial artery embolization. After this procedure, his symptoms resolved completely and he was discharged after a week with 2nd category anti-tuberculosis drugs (ATD). 6 months of follow-up, he no longer experienced hemoptysis.Conclusion: Recurrent hemoptysis needs optimal management, including diagnostic with chest radiography, CT and bronchoscopy. Treatment with bronchoscopy and bronchial artery embolization will reduce mortality and morbidity in patients with hemoptysis.

Haemoptysis in Pulmonary Arterial Hypertension Associated with Congenital Heart Disease: Insights on Pathophysiology, Diagnosis and Management.

Haemoptysis represents one of the most severe major bleeding manifestations in the clinical course of pulmonary arterial hypertension (PAH) associated with congenital heart disease (CHD). Accumulating evidence indicates that dysfunction of the pulmonary vascular bed in the setting of PAH predisposes patients to increased hemorrhagic diathesis, resulting in mild to massive and life-threatening episodes of haemoptysis. Despite major advances in PAH targeted treatment strategies, haemoptysis is still correlated with substantial morbidity and impaired quality of life, requiring a multidisciplinary approach by adult CHD experts in tertiary centres. Technological innovations in the field of diagnostic and interventional radiology enabled the application of bronchial artery embolization (BAE), a valuable tool to efficiently control haemoptysis in modern clinical practice. However, bleeding recurrences are still prevalent, implying that the optimum management of haemoptysis and its implications remain obscure. Moreover, regarding the use of oral anticoagulation in patients with haemoptysis, current guidelines do not provide a clear therapeutic strategy due to the lack of evidence. This review aims to discuss the main pathophysiological mechanisms of haemoptysis in PAH-CHD, present the clinical spectrum and the available diagnostic tools, summarize current therapeutic challenges, and propose directions for future research in this group of patients.

Massive hemoptysis treated with embolization of an ectopic bronchial artery arising from the right thyrocervical trunk: a case report

BackgroundEctopic bronchial artery and non-bronchial systemic arteries may be the culprit vessels of hemoptysis. The main cause of clinical failure of bronchial artery embolization is incomplete embolization caused by the misidentification of the culprit arteries by conventional angiography. Multidetector computed tomography angiography is useful for visualizing the culprit arteries.Case presentationAn 82-year-old man was admitted with hemoptysis. Preprocedural multidetector computed tomography angiography revealed an ectopic bronchial artery branching from the right thyrocervical trunk. Superselective embolization of the ectopic bronchial artery was performed using gelatin sponge particles and metallic coils. Hemoptysis was controlled by this procedure without any associated complications.ConclusionsEctopic bronchial arteries originating from the thyrocervical trunk are rare. Preprocedural multidetector computed tomography angiography is useful for visualizing the culprit arteries of hemoptysis, especially if a patient has an ectopic bronchial artery or an ectopic non-bronchial systemic artery.

Clinical characteristics and postoperative outcomes of systemic artery-to-pulmonary vessel fistula in hemoptysis patients.

To investigate the clinical characteristics and outcomes on the success of bronchial arterial embolization (BAE) in patients with and without systemic artery-to-pulmonary vessel fistula (SA-PF) and to evaluate the feasibility of CTA in the assessment of SA-PF. We retrospectively enrolled 420 consecutive patients that underwent BAE for hemoptysis control in our hospital from September 2011 to May 2019. The clinical characteristics, preprocedural CTA findings, BAE procedural findings, and follow-up outcomes were collected. Patients were divided into two groups according to DSA findings: patients with SA-PF and those without. A total of 184 (43.7%) patients presented with SA-PF. Pneumonia was less likely to be the concomitant condition in patients with SA-PF (p < 0.001). The mean number of culprit arteries per patient was significantly higher in patients with SA-PF compared to that in patients without SA-PF (p = 0.017). The SA-PF patients saw a greater probability of recurrence (HR: 2.782, 95% CI: 1.617-4.784, p < 0.001). SA-pulmonary venous fistula (SA-PVF) favored lower hemoptysis recurrence rate (HR: 0.199, 95%CI: 0.052-0.765, p = 0.019). SA-pulmonary artery fistula (SA-PAF) can be detected by optimized CTA protocol with a detection rate of 65.3% (49/75). The presence of SA-PF is an independent risk factor predicting early recurrence of hemoptysis after BAE. SA-PVF seems to be a protective factor for longer hemoptysis control compared to SA-PAF. Optimized preprocedural CTA is a reliable examination to identify SA-PAF. • The appearance of SA-PF is associated with a greater probability of early recurrent hemoptysis after bronchial artery embolization. • The presence of SA-PVF seems to be a protective factor for longer hemoptysis control after BAE compared to SA-PAF. • Optimized CTA protocol seems to be a promising auxiliary examination to detect SA-PAF.

A Longitudinal Study Evaluating Indications, Section Efficacy and Complications of Bronchial Artery Embolisation

Introduction: Embolisation is defined as the therapeutic introduction of Gelfoam or Poly-Vinyl Alcohol (PVA) particles into the circulation to occlude vessels. Selective embolisation of the bronchial arteries feeding the affected areas could be more effective than surgical intervention which is more hazardous leading to prolong Intensive Care Unit (ICU) stay, air leaks, stump infection. Aim: To study various indications, success rate, complications, and recurrence after Bronchial Artery Embolisation (BAE). Materials and Methods: The present longitudinal study was conducted in the Department of Pulmonary Medicine in collaboration with the Department of Interventional Radiology in Grant Medical College and JJ hospital, Mumbai, Maharashtra, India from December 2016 to December 2017. The study was done on 50 patients admitted in view of moderate to massive haemoptysis. Common indications requiring BAE, success rate with gelfoam or PVA particles, and common complications of the procedure were studied. Mean age of presentation with haemoptysis, co-morbidities associated with the disease were also studied. The patients were followed-up for six months. Repeat BAE was done in patients with PVA particles before referring for surgical intervention in cases with recurrent haemoptysis. Results: The mean age of patients requiring BAE was 37.98 years, with male predominance. Most common indication was pulmonary tuberculosis followed by post-tuberculosis sequelae. The overall success rate of the procedure was 88% at six months follow-up.BAE done with PVA (10/10) particle showed a better outcome as compared to gelfoam (34/40). The most common complication related to the procedure was puncture site pain. Three patients out of six with recurrent haemoptysis required repeat BAE within three months, out of which only one required surgery. Conclusion: The most common indication for BAE in this study was pulmonary tuberculosis. There were no major complications, even with repeat BAE. Hence, BAE should be the procedure of choice for moderate to massive haemoptysis despite of previous history of BAE, before considering for surgical intervention. BAE with PVA is associated with better success rate.

Effect Evaluation of Bronchial Artery Embolization for Hemoptysis of Lung Cancer and Changes in Serum Tumor Markers and miR-34 Levels.

The clinical efficacy, serum tumor markers, and miR-34 expression levels of bronchial artery embolization (BAE) in patients with lung cancer with hemoptysis are investigated. 92 patients with lung cancer hemoptysis treated in our hospital from January 2019 to December 2021 are randomly selected, and 92 patients are randomly divided into the conservative group and the BAE group according to the number table method, with 46 patients in each group. The efficacy, overall survival (OS) rate, coagulation function, hemoptysis volume, serum tumor markers, and miR-34 expression are compared among all groups at different time points. The experimental results show that the BAE treatment can promote the expression of miR-34 and inhibit the expression of tumor markers, so it can improve the efficacy of patients with lung cancer hemoptysis, improve the symptoms of hemoptysis and coagulation function, and prolong the life cycle of patients.