Ectopic origin of bronchial arteries: still a potential pitfall in embolization

Area of Science:

• Interventional Radiology
• Vascular Anatomy
• Pulmonary Medicine

Background:

• Bronchial artery embolization (BAE) is a primary treatment for hemoptysis.
• Anatomical variations, such as ectopic bronchial arteries (BAs), can influence BAE procedures.
• Understanding these variations is critical for procedural success and patient safety.

Purpose of the Study:

• To evaluate the impact of ectopic bronchial arteries (BAs) on the efficacy and safety of bronchial artery embolization (BAE) for managing hemoptysis.
• To identify the origins and prevalence of ectopic BAs in patients undergoing BAE.

Main Methods:

• Retrospective review of CT and angiography images from 50 BAE sessions in 39 hemoptysis patients.
• Definition of ectopic BA: a systemic artery originating outside the T5-T6 level of the descending aorta, coursing along major bronchi.
• Comparison of patient demographics, number of BAs, culprit arteries, and outcomes between patients with and without ectopic BAs.

Main Results:

• Ectopic BAs were identified in 43.6% of patients (19 out of 19), originating from various systemic arteries including the subclavian and aortic arch.
• Patients with ectopic BAs had a significantly higher total number of BAs.
• While BAE was feasible and safe, four cases showed unintended contrast or embolic material migration to ectopic BAs via small communications.

Conclusions:

• Bronchial artery embolization (BAE) is feasible and safe even in the presence of ectopic bronchial arteries (BAs).
• Pre-procedural detection of all BAs, including those with ectopic origins, is essential.
• Identifying ectopic BAs helps mitigate the risk of non-target embolization and improves treatment outcomes.