BRONCHIAL ARTERY EMBOLIZATION: NON BRONCHIAL ARTERIAL SOURCES OF MASSIVE HEMOPTYSIS

Abstract

Introduction: Bronchial artery embolization (BAE) is a procedure of choice in those patients who have massive hemoptysis and they are poor surgical candidates for lung resection. Source of bleeding in patients with massive hemoptysis is mainly from bronchial artery but non bronchial systemic arteries are also significant contributiors. Knowledge of their anatomy and anatomic variations are important to the operator. In this study we evaluate the contribution of non-bronchial systemic arteries in the causation of massive hemoptysis in patients under going bronchial artery embolization (BAE). Patients and Methods: Two years of patients who underwent embolization for massive hemoptysis in our department data was retrospectively evaluated. All patients had physical examination, chest x-ray, chest computed tomography (CT), and fiber optic bronchoscopy before the procedure. Bronchial and non bronchial arterial angiography and embolization was performed with standard protocols. These angiograms were analyzed by two radiologists with over 5 years of experience in angiography. We recorded all feeders which were supplying the lesion e.g. bronchial artery, phrenic artery, intercostals artery, internal mammary artery & its branches, branches of subclavian (other than internal mammary artery) and axillary arteries. Results: All 22 patients had bronchial artery contributing (100%) to the hemoptysis. Ten (45.5%) patients had only bronchial artery supply without contribution from non-bronchial systemic arteries. Remaining twelve (54.5%) patients had mixed arterial supply from bronchial and non bronchial arteries. A total of 50 arteries were embolized in twenty-three sessions of embolization in twenty-two patients. Total 28 (56%) non bronchial arteries were contributing the massive hemoptysis. The breakup of non bronchial arterial contribution are 3 (10.7%) phrenic arteries, 11 (39.2%) intercostals arteries, 06 (21.4%) internal mammary arteries and 06 (21.4%) arterial branches of subclavian (other than internal mammary artery) and axillary arteries Except 01 patient, no other recurrence was observed in thirty days followup. Conclusion: In our study more than half of patients had non bronchial systemic arterial source of their hemoptysis. Therefore it is important to search for non bronchial arterial contribution in cases of massive hemoptysis when performing endovascular embolization. KEY WORDS : Bronchial artery, angiography, embolization