Bronchial artery embolization: experience with 10 cases

To report our experience with 10 cases of bronchial artery embolization (BAE).

The study included 18 cases (11 men and 7 women between 21 and 81 years of age, average 52 years), whose massive hemoptyses could not be controlled with conservative and bronchoscopic methods and were sent to the digital subtraction angiography unit between August 2002 and May 2004. Of these 18 cases, BAE was performed in 10 (7 men and 3 women between 21 and 78 years of age, average 54.2 years). An aortogram with a 5F pigtail catheter and a selective bronchial angiogram with a 4F glide Cobra (C2) catheter was obtained in every case. The same C2 catheters that had been used for bronchial angiography were also used for BAE in 7 cases. Hydrophilic microcatheters were additionally needed for BAE in the other 3 cases. Particles > 250 microns (polyvinyl alcohol [PVA], Embosphere microspheres), mechanical coils, or a combination of both were used for BAE.

The etiologies of 10 cases in which BAE was performed were tuberculosis (n=3), sarcoidosis (n=3), bronchiectasis (n=2), and malignancy (n=2). Arterial bronchial pathology was also seen in the non-selective angiographic studies of 4 of the 10 BAE cases. Hemoptysis was controlled in all BAE cases in the first session. Recurrences were observed in 2 cases that were embolized with only mechanical coils during the first month follow-up and hemoptysis was again controlled with microparticle embolization with Embosphere microspheres. All 10 cases were followed- up for 1-21 months (average, 8 months).

Non-selective angiographic examination alone, is not sufficient enough to detect the vascular pathology causing a massive hemoptysis. A selective study must be performed in every case. The cost of angiography can be lowered by using the same 4F glide C2 catheter for BAE. It may not be safe to use only mechanical coils in BAE cases. There is a need for studying additional cases to have more definitive conclusions.