Bronchial Artery Embolization for Hemoptysis

Manrita Sidhu; Karen Wieseler; Thomas R. Burdick; Dennis W. W. Shaw

doi:10.1055/s-0028-1085931

Seminars in Interventional Radiology, Inhaltsverzeichnis

Semin intervent Radiol 2008; 25(3): 310-318
DOI: 10.1055/s-0028-1085931

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

Abstract

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

Volltext

Referenzen

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
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
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
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
5 White R I. Bronchial artery embolotherapy for control of acute hemoptysis: analysis of outcome. Chest. 1999; 115(4) 912-915
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
7 Håkanson E, Konstantinov I, Fransson S, Svedjeholm R. Management of life-threatening haemoptysis. Br J Anaesth. 2002; 88(2) 291-295
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
9 Stoller J. Diagnosis and management of massive hemoptysis: a review. Respir Care. 1992; 37(6) 564-581
10 Najarian K E, Morris C S. Arterial embolization in the chest. J Thorac Imaging. 1998; 13(2) 93-104
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
12 Andersen P E. Imaging and interventional radiological treatment of hemoptysis. Acta Radiol. 2006; 47(8) 780-792
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
14 Jean-Baptiste E. Clinical assessment and management of massive hemoptysis. Crit Care Med. 2000; 28(5) 1642-1647
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
16 Pelage J P, El Hajjam M, Lagrange C et al.. Pulmonary artery interventions: an overview. Radiographics. 2005; 25(6) 1653-1667
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
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
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
20 Bruzzi J F, Rémy-Jardin M, Delhaye D et al.. Multi-detector row CT of hemoptysis. Radiographics. 2006; 26(1) 3-22
21 Pump K K. Distribution of bronchial arteries in the human lung. Chest. 1972; 62(4) 447-451
22 Ellis K. Fleischner lecture. Developmental abnormalities in the systemic blood supply to the lungs. AJR Am J Roentgenol. 1991; 156(4) 669-679
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
24 Roberts A C. Bronchial artery embolization therapy. J Thorac Imaging. 1990; 5(4) 60-72
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
26 Cauldwell E, Siekert R, Lininger R. The bronchial arteries: an anatomic study of 150 cadavers. Surg Gynecol Obstet. 1948; 86 395-412
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
28 Sancho C, Escalante E, Domínguez J et al.. Embolization of bronchial arteries of anomalous origin. Cardiovasc Intervent Radiol. 1998; 21(4) 300-304
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
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
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
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
33 Sweezey N B, Fellows K E. Bronchial artery embolization for severe hemoptysis in cystic fibrosis. Chest. 1990; 97(6) 1322-1326
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
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
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
37 Stoll J F, Bettmann M A. Bronchial artery embolization to control hemoptysis: a review. Cardiovasc Intervent Radiol. 1988; 11(5) 263-269
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
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
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
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
42 Marshall T J, Jackson J E. Vascular intervention in the thorax: bronchial artery embolization for haemoptysis. Eur Radiol. 1997; 7(8) 1221-1227
43 Karmy-Jones R, Hastreiter D, Burdick T. Hemothorax complicating bronchial artery aneurysm. Can Respir J. 2005; 12(5) 279-281
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
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
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
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

Manrita SidhuM.D.

Seattle Radiologists, Advanced Imaging Center

3927 Rucker Avenue, Everett, WA 98201

eMail: manritasidhu@gmail.com