Embolization for Hemoptysis—Angiographic Anatomy of Bronchial and Systemic Arteries

Abstract

Massive hemoptysis is a potentially fatal respiratory emergency. The majority of these patients are referred to interventional radiology for bronchial artery embolization (BAE). Immediate clinical success in stopping hemoptysis ranges from 70 to 99%. However, recurrent hemoptysis after BAE is seen in 10 to 55% patients. One of the main reasons for recurrence is incomplete embolization due to unidentified aberrant bronchial and/or non-bronchial systemic arterial supply. This pictorial essay aims to describe the normal and variant bronchial arterial anatomy and non-bronchial systemic arterial feeders to the lungs on conventional angiography; the knowledge of which is critical for interventional radiologists involved in the care of patients with hemoptysis.

Keywords

bronchial - embolization - hemoptysis

• References

• 1 Sopko DR, Smith TP. Bronchial artery embolization for hemoptysis. Semin Intervent Radiol 2011; 28 (01) 48-62
• 2 Yoon W, Kim JK, Kim YH, Chung TW, Kang HK. Bronchial and nonbronchial systemic artery embolization for life-threatening hemoptysis: a comprehensive review. Radiographics 2002; 22 (06) 1395-1409
• 3 Angle JF, Siddiqi NH, Wallace MJ. et al; Society of Interventional Radiology Standards of Practice Committee. Quality improvement guidelines for percutaneous transcatheter embolization: Society of Interventional Radiology Standards of Practice Committee. J Vasc Interv Radiol 2010; 21 (10) 1479-1486
• 4 Woo S, Yoon CJ, Chung JW. et al. Bronchial artery embolization to control hemoptysis: comparison of N-butyl-2-cyanoacrylate and polyvinyl alcohol particles. Radiology 2013; 269 (02) 594-602
• 5 Marshall TJ, Jackson JE. Vascular intervention in the thorax: bronchial artery embolization for haemoptysis. Eur Radiol 1997; 7 (08) 1221-1227
• 6 Stoll JF, Bettmann MA. Bronchial artery embolization to control hemoptysis: a review. Cardiovasc Intervent Radiol 1988; 11 (05) 263-269
• 7 Cauldwell EW, Siekert RG, Lininger RE, Anson BJ. The bronchial arteries: an anatomic study of 150 human cadavers. Surg Gynecol Obstet 1948; 86 (04) 395-412
• 8 Battal B, Akgun V, Karaman B, Bozlar U, Tasar M. Normal anatomical features and variations of bronchial arteries: an analysis with 64-detector-row computed tomographic angiography. J Comput Assist Tomogr 2011; 35 (02) 253-259
• 9 Yener Ö, Türkvatan A, Yüce G, Yener AÜ. The normal anatomy and variations of the bronchial arteries: evaluation with multidetector computed tomography. Can Assoc Radiol J 2015; 66 (01) 44-52
• 10 McPherson S, Routh WD, Nath H, Keller FS. Anomalous origin of bronchial arteries: potential pitfall of embolotherapy for hemoptysis. J Vasc Interv Radiol 1990; 1 (01) 86-88
• 11 Gailloud P, Albayram S, Heck DV, Murphy KJ, Fasel JH. Superior bronchial artery arising from the left common carotid artery: embryology and clinical considerations. J Vasc Interv Radiol 2002; 13 (08) 851-853
• 12 Jiang S, Sun XW, Jie B, Yu D. Endovascular embolization of an aberrant bronchial artery originating from the vertebral artery in a patient with massive hemoptysis. Cardiovasc Intervent Radiol 2014; 37 (04) 1099-1102
• 13 Battal B, Saglam M, Ors F, Akgun V, Dakak M. Aberrant right bronchial artery originating from right coronary artery - MDCT angiography findings. Br J Radiol 2010; 83 (989) e101-e104
• 14 Hartmann IJ, Remy-Jardin M, Menchini L, Teisseire A, Khalil C, Remy J. Ectopic origin of bronchial arteries: assessment with multidetector helical CT angiography. Eur Radiol 2007; 17 (08) 1943-1953
• 15 Cohen AM, Antoun BW, Stern RC. Left thyrocervical trunk bronchial artery supplying right lung: source of recurrent hemoptysis in cystic fibrosis. AJR Am J Roentgenol 1992; 158 (05) 1131-1133