Download PDF
Semin intervent Radiol 2008; 25(3): 310-318
DOI: 10.1055/s-0028-1085931
© by Thieme Medical Publishers

Bronchial Artery Embolization for Hemoptysis

Manrita Sidhu1 , 2 , 4 , Karen Wieseler2 , Thomas R. Burdick2 , 3 , Dennis W. W Shaw1 , 2
  • 1Children's Hospital and Regional Medical Center, Seattle, Washington
  • 2University of Washington School of Medicine, Seattle, Washington
  • 3Harborview Medical Center, Seattle, Washington
  • 4Seattle Radiologists, Advanced Imaging Center, Everett, Washington
Further Information

Publication History

Publication Date:
30 September 2008 (online)

Also available at
    Permissions and Reprints

ABSTRACT

Bronchial artery bleeding is the most common cause of life-threatening hemoptysis. The most common underlying etiologies include tuberculosis, bronchiectasis, aspergillosis, and cystic fibrosis. 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. In this article, the relevant anatomy and pathophysiology leading to bronchial artery bleeding is discussed, including the roles of parenchymal lung diseases and of collateral and aberrant vessels. The indications for treatment, success rate, and complication rate for bronchial artery embolization are reviewed. Preprocedure clinical stabilization and evaluation, including the roles of radiographs, bronchoscopy, and computed tomography examination are evaluated. Details of technique, including the published variety of approaches, and an emphasis on avoidance of nontarget embolization of important mediastinal structures and of the anterior spinal artery are discussed.

KEYWORDS

Hemoptysis - bronchial artery - embolization - selective angiography

REFERENCES

  • 1 Thompson A B, Teschler H, Rennard S I. Pathogenesis, evaluation, and therapy for massive hemoptysis.  Clin Chest Med. 1992;  13(1) 69-82
    PubMedGoogle Scholar
  • 2 Yoon W, Kim J, Kim Y, Chung T, Kang H. Bronchial and nonbronchial systemic artery embolization for life-threatening hemoptysis: a comprehensive review.  Radiographics. 2002;  22(6) 1395-1409
    CrossrefPubMedGoogle Scholar
  • 3 Magilligan D J, Ravipati S, Zayat P et al.. Massive hemoptysis: control by transcatheter bronchial artery embolization.  Ann Thorac Surg. 1981;  32(4) 392-400
    PubMedGoogle Scholar
  • 4 Rémy J, Arnaud A, Fardou H, Giraud R, Voisin C. Treatment of hemoptysis by embolization of bronchial arteries.  Radiology. 1977;  122(1) 33-37
    CrossrefPubMedGoogle Scholar
  • 5 White R I. Bronchial artery embolotherapy for control of acute hemoptysis: analysis of outcome.  Chest. 1999;  115(4) 912-915
    CrossrefPubMedGoogle Scholar
  • 6 Brinson G M, Noone P G, Mauro M A et al.. Bronchial artery embolization for the treatment of hemoptysis in patients with cystic fibrosis.  Am J Respir Crit Care Med. 1998;  157(6 Pt 1) 1951-1958
    CrossrefPubMedGoogle Scholar
  • 7 Håkanson E, Konstantinov I, Fransson S, Svedjeholm R. Management of life-threatening haemoptysis.  Br J Anaesth. 2002;  88(2) 291-295
    CrossrefPubMedGoogle Scholar
  • 8 Mal H, Rullon I, Mellot F et al.. Immediate and long-term results of bronchial artery embolization for life-threatening hemoptysis.  Chest. 1999;  115(4) 996-1001
    CrossrefPubMedGoogle Scholar
  • 9 Stoller J. Diagnosis and management of massive hemoptysis: a review.  Respir Care. 1992;  37(6) 564-581
    PubMedGoogle Scholar
  • 10 Najarian K E, Morris C S. Arterial embolization in the chest.  J Thorac Imaging. 1998;  13(2) 93-104
    CrossrefPubMedGoogle Scholar
  • 11 Cohen A M, Doershuk C F, Stern R C. Bronchial artery embolization to control hemoptysis in cystic fibrosis.  Radiology. 1990;  175(2) 401-405
    CrossrefPubMedGoogle Scholar
  • 12 Andersen P E. Imaging and interventional radiological treatment of hemoptysis.  Acta Radiol. 2006;  47(8) 780-792
    CrossrefPubMedGoogle Scholar
  • 13 Fellows K E, Khaw K T, Schuster S, Shwachman H. Bronchial artery embolization in cystic fibrosis; technique and long-term results.  J Pediatr. 1979;  95(6) 959-963
    CrossrefPubMedGoogle Scholar
  • 14 Jean-Baptiste E. Clinical assessment and management of massive hemoptysis.  Crit Care Med. 2000;  28(5) 1642-1647
    CrossrefPubMedGoogle Scholar
  • 15 Tringali S, Tiffet O, Berger J, Cuilleret J. Bronchial artery aneurysm disguised as a leiomyoma of the esophagus.  Ann Thorac Surg. 2002;  73(2) 632-633
    CrossrefPubMedGoogle Scholar
  • 16 Pelage J P, El Hajjam M, Lagrange C et al.. Pulmonary artery interventions: an overview.  Radiographics. 2005;  25(6) 1653-1667
    CrossrefPubMedGoogle Scholar
  • 17 Saluja S, Henderson K, White R J. Embolotherapy in the bronchial and pulmonary circulations.  Radiol Clin North Am. 2000;  38(2) 425-448 ix
    CrossrefPubMedGoogle Scholar
  • 18 Pollak J S, Saluja S, Thabet A et al.. Clinical and anatomic outcomes after embolotherapy of pulmonary arteriovenous malformations.  J Vasc Interv Radiol. 2006;  17(1) 35-44 , quiz 45
    CrossrefPubMedGoogle Scholar
  • 19 Liebow A A, Hales M R, Lindskog G E. Enlargement of the bronchial arteries, and their anastomoses with the pulmonary arteries in bronchiectasis.  Am J Pathol. 1949;  25(2) 211-231
    PubMedGoogle Scholar
  • 20 Bruzzi J F, Rémy-Jardin M, Delhaye D et al.. Multi-detector row CT of hemoptysis.  Radiographics. 2006;  26(1) 3-22
    CrossrefPubMedGoogle Scholar
  • 21 Pump K K. Distribution of bronchial arteries in the human lung.  Chest. 1972;  62(4) 447-451
    CrossrefPubMedGoogle Scholar
  • 22 Ellis K. Fleischner lecture. Developmental abnormalities in the systemic blood supply to the lungs.  AJR Am J Roentgenol. 1991;  156(4) 669-679
    CrossrefPubMedGoogle Scholar
  • 23 Swanson K L, Johnson C M, Prakash U B et al.. Bronchial artery embolization: experience with 54 patients.  Chest. 2002;  121(3) 789-795
    CrossrefPubMedGoogle Scholar
  • 24 Roberts A C. Bronchial artery embolization therapy.  J Thorac Imaging. 1990;  5(4) 60-72
    PubMedGoogle Scholar
  • 25 Rémy-Jardin M, Bouaziz N, Dumont P et al.. Bronchial and nonbronchial systemic arteries at multi-detector row CT angiography: comparison with conventional angiography.  Radiology. 2004;  233(3) 741-749
    CrossrefPubMedGoogle Scholar
  • 26 Cauldwell E, Siekert R, Lininger R. The bronchial arteries: an anatomic study of 150 cadavers.  Surg Gynecol Obstet. 1948;  86 395-412
    PubMedGoogle Scholar
  • 27 Uflacker R, Kaemmerer A, Picon P et al.. Bronchial artery embolization in the management of hemoptysis: technical aspects and long-term results.  Radiology. 1985;  157(3) 637-644
    CrossrefPubMedGoogle Scholar
  • 28 Sancho C, Escalante E, Domínguez J et al.. Embolization of bronchial arteries of anomalous origin.  Cardiovasc Intervent Radiol. 1998;  21(4) 300-304
    CrossrefPubMedGoogle Scholar
  • 29 Tamura S, Kodama T, Otsuka N et al.. Embolotherapy for persistent hemoptysis: the significance of pleural thickening.  Cardiovasc Intervent Radiol. 1993;  16(2) 85-88
    PubMedGoogle Scholar
  • 30 Yoon W, Kim Y, Kim J et al.. Massive hemoptysis: prediction of nonbronchial systemic arterial supply with chest CT.  Radiology. 2003;  227(1) 232-238
    CrossrefPubMedGoogle Scholar
  • 31 Takase K, Sawamura Y, Igarashi K et al.. Demonstration of the artery of Adamkiewicz at multi- detector row helical CT.  Radiology. 2002;  223(1) 39-45
    CrossrefPubMedGoogle Scholar
  • 32 Hsiao E I, Kirsch C M, Kagawa F T et al.. Utility of fiberoptic bronchoscopy before bronchial artery embolization for massive hemoptysis.  AJR Am J Roentgenol. 2001;  177(4) 861-867
    PubMedGoogle Scholar
  • 33 Sweezey N B, Fellows K E. Bronchial artery embolization for severe hemoptysis in cystic fibrosis.  Chest. 1990;  97(6) 1322-1326
    PubMedGoogle Scholar
  • 34 Abal A T, Nair P C, Cherian J. Haemoptysis: aetiology, evaluation and outcome–a prospective study in a third-world country.  Respir Med. 2001;  95(7) 548-552
    CrossrefPubMedGoogle Scholar
  • 35 Rémy J, Voisin C, Dupuis C et al.. Traitement des hemoptysies par embolisation de la circulation systemique.  Ann Radiol (Paris). 1974;  17 5-16
    PubMedGoogle Scholar
  • 36 Wholey M H, Chamorro H A, Rao G, Ford W B, Miller W H. Bronchial artery embolization for massive hemoptysis.  JAMA. 1976;  236(22) 2501-2504
    CrossrefPubMedGoogle Scholar
  • 37 Stoll J F, Bettmann M A. Bronchial artery embolization to control hemoptysis: a review.  Cardiovasc Intervent Radiol. 1988;  11(5) 263-269
    CrossrefPubMedGoogle Scholar
  • 38 Tanaka N, Yamakado K, Murashima S et al.. Superselective bronchial artery embolization for hemoptysis with a coaxial microcatheter system.  J Vasc Interv Radiol. 1997;  8(1 Pt 1) 65-70
    CrossrefPubMedGoogle Scholar
  • 39 Schrodt J F, Becker G J, Scott J A, Warren C H, Benenati S V. Bronchial artery embolization: monitoring with somatosensory evoked potentials. Work in progress.  Radiology. 1987;  164(1) 135-139
    CrossrefPubMedGoogle Scholar
  • 40 Ramakantan R, Bandekar V, Gandhi M, Aulakh B, Deshmukh H. Massive hemoptysis due to pulmonary tuberculosis: control with bronchial artery embolization.  Radiology. 1996;  200(3) 691-694
    CrossrefPubMedGoogle Scholar
  • 41 Corr P D. Bronchial artery embolization for life-threatening hemoptysis using tris-acryl microspheres: short-term result.  Cardiovasc Intervent Radiol. 2005;  28(4) 439-441
    CrossrefPubMedGoogle Scholar
  • 42 Marshall T J, Jackson J E. Vascular intervention in the thorax: bronchial artery embolization for haemoptysis.  Eur Radiol. 1997;  7(8) 1221-1227
    CrossrefPubMedGoogle Scholar
  • 43 Karmy-Jones R, Hastreiter D, Burdick T. Hemothorax complicating bronchial artery aneurysm.  Can Respir J. 2005;  12(5) 279-281
    PubMedGoogle Scholar
  • 44 Bredin C P, Richardson P R, King T K et al.. Treatment of massive hemoptysis by combined occlusion of pulmonary and bronchial arteries.  Am Rev Respir Dis. 1978;  117(5) 969-973
    PubMedGoogle Scholar
  • 45 Kato A, Kudo S, Matsumoto K et al.. Bronchial artery embolization for hemoptysis due to benign diseases: immediate and long-term results.  Cardiovasc Intervent Radiol. 2000;  23(5) 351-357
    CrossrefPubMedGoogle Scholar
  • 46 Yu-Tang Goh P, Lin M, Teo N, En Shen Wong D. Embolization for hemoptysis: a six -year review.  Cardiovasc Intervent Radiol. 2002;  25(1) 17-25
    CrossrefPubMedGoogle Scholar
  • 47 Hayakawa K, Tanaka F, Torizuka T et al.. Bronchial artery embolization for hemoptysis: immediate and long-term results.  Cardiovasc Intervent Radiol. 1992;  15(3) 154-158 discussion 158-159
    CrossrefPubMedGoogle Scholar

Manrita SidhuM.D. 

Seattle Radiologists, Advanced Imaging Center

3927 Rucker Avenue, Everett, WA 98201

Email: manritasidhu@gmail.com