Bronchial artery embolization
Causes- cystic fibrosis, bronchial tumors, TB, airway, parenchyma, and cardiovascular causes. Trauma, foreign body.
Pathophysiology- localized hypoxia, decreased PA perfusion, angiogenesis from bronchial arteries, disordered and will bleed
bronchial arteries supply airways, vasa vasorum pulmonary arteries, esophagus
for CF: need to embolize all bilateral bronchial supply including both IMA branches
other sources of hemoptysis- from subclavian, etc
evaluation- h/o- infection, vasculitis, granulomas, airway disease. Ask patient which side. Localization can be difficult as CXR can be negative 30% of the time. Consider bronchoscopy (depends on practice pattern). CT/CTA- see bronchial arteries and helps with localization.5% has PA as offending branch.
complications- anterior spinal artery which is high risk for nontarget embolization, 1.5-6.5%. Shutting via PV systemic circulation. Chest pain which is self limiting.transient dysphasia.
Enlarged bronchial arteries, aneurysms, shunting to PA or PV, active extravasation is less common (about 10%).
Mickelson catheter for access
Microcatheter (2.8) can be used to extend 5F catheter to assist in selection
- Embospheres 500-700um
- PVA- use>300um.
- Gelfoam - don't use due to clogging of catheter.
- Onyx, NCBA. Coils- would not use lubes there is a pseudoaneurysm.
Outcomes - technical success >90%, clinical success 73-99%, 10-50% recurrence rate. Low success rates in earlier studies with gelfoam.