Bronchial artery embolization for Hemoptysis
Hemoptysis is the coughing up of blood or blood-stained mucus/sputum. This can occur with lung cancer, infections such as tuberculosis, bronchitis, or pneumonia, and certain cardiovascular conditions.
Many patients get lung infections or sometimes tumors which lead to bleeding in the sputum. Lungs have dual blood supply. 98% blood is supplied by the pulmonary arteries. 2% of the blood is supplied by tiny blood vessels called bronchial arteries. While they are not very important for the lung in normal people, infections or tumors lead to their hypertrophy and result in bleeding from them sometimes amounting to massive proportions. These are the patients in whom the bleeding needs to be dealt with urgently as a life saving measure.
PRE-REQUITES
- CT angiography chest (hemoptysis protocol) to confirm the etiology and map hypertrophied bronchial vessels and also to rule out other causes of bleed like pulmonary artery.
- Blood tests to determine if the intervention can be safely performed:- CBC, PT/INR, Sr.Creatinine, Viral markers.
- 3-4 hours of fasting before procedure
- Shaving of bilateral groin.
- Pulmonological work up like sputum examination, bronchoscopy, Mantoux test.
TECHNIQUE
Using the angiography route (most commonly via the right groin), a small sheath (plastic hollow tube) is placed in the thigh blood vessel. This is done after local anesthesia injection. After this, under fluoroscopic (live x-ray) guidance multiple catheters can be used from that sheath/access to move into the aorta (main blood vessel from heart supplying blood to all organs). The bronchial arteries are selectively cannulated and once angiography is done to confirm that those arteries are the cause of bleeding, they are embolized using particles (made up of poly-vinyl alcohol). They get permanently destroyed and very recanalize again.
