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Permanent cortical blindness after bronchial artery embolization.

Colette S van Doorn¹, Diederick W De Boo², Els J M Weersink³

¹Department of Radiology, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.

Cardiovascular and Interventional Radiology

|April 13, 2013

Summary

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Massive hemoptysis treatment via bronchial artery embolization (BAE) led to permanent blindness in a cystic fibrosis patient due to an unexpected artery connection. This case highlights risks of embolization in patients with complex vascular anatomy.

Area of Science:

Interventional Radiology
Vascular Surgery
Neurology

Background:

Cystic fibrosis patients may experience massive hemoptysis.
Bronchial artery embolization (BAE) is a treatment for hemoptysis.

Observation:

A 35-year-old cystic fibrosis patient presented with massive hemoptysis.
CTA revealed a hypertrophied right upper lobe bronchial artery with active bleeding.
BAE was performed due to significant shunting to the pulmonary artery.

Findings:

Immediately post-BAE, the patient developed bilateral cortical blindness.
Angiography identified an unvisualized anastomosis between the bronchial artery and the right subclavian artery.
Embolization material refluxed into the posterior circulation via this anastomosis, causing permanent blindness.

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Implications:

This case underscores the critical importance of meticulous pre-procedural vascular assessment.
Unforeseen anastomoses can lead to catastrophic complications during embolization procedures.
Awareness of potential arterial connections is vital for patient safety in interventional radiology.