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Ectopic origin of bronchial arteries: still a potential pitfall in embolization

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Abstract

Purpose

To evaluate the influence of ectopic origin of bronchial arteries (BAs) on bronchial artery embolization (BAE) for hemoptysis.

Methods

CT and angiography images of 50 consecutive sessions in 39 patients (aged 26–93 years; mean, 70.6 years) who underwent BAE for hemoptysis from April 2010 to December 2019 were reviewed. We defined ectopic BA as a systemic artery originating from other than the T5–T6 vertebral level of the descending aorta with course along the major bronchi. The background of patients, number of BAs, culprit arteries, and treatment outcomes were compared between the cases with and without ectopic BAs.

Results

Seventeen patients (43.6%) demonstrated 19 ectopic BAs, originating from the subclavian artery (n = 7), aortic arch above the T5–T6 level (n = 6), internal mammary artery (n = 3), brachiocephalic trunk (n = 2) or lower descending thoracic aorta (n = 1). Total number of BAs in the cases with ectopic BA was significantly greater than those in cases without ectopic BA (p = 0.0062). Required sessions of embolization were similar in the two groups. No procedure-related significant complications were noted; however, four ectopic BAs caused unexpected filling of contrast media or migration of the embolic material from the orthotopic BA to ectopic BA originating from the arch vessels via tiny communication.

Conclusion

Although BAE under the presence of ectopic BA is feasible and safe, detection of BAs with ectopic origin, even of small diameter, is needed to avoid risk of non-target coursing of embolic materials.

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Authors and Affiliations

  1. Department of Radiology, Fuji City General Hospital, 50 Takashimacho, Fuji-shi, Shizuoka, 417-8567, Japan

    Kenkichi Michimoto

  2. Department of Radiology, The Jikei University Katsushika Medical Center, 6-41-2 Aoto, Katsushika-ku, Tokyo, 125-8506, Japan

    Shinsuke Takenaga

  3. Department of Radiology, The Jikei University School of Medicine, 3-19-18 Nishishimbashi, Minato-ku, Tokyo, 105-8471, Japan

    Yo Matsui, Yosuke Nozawa & Rui Kano

  4. Department of Radiology, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa-shi, Chiba, 277-8567, Japan

    Keitaro Enoki & Takahiro Higuchi

  5. Department of Internal Medicine, Fuji City General Hospital, 50 Takashimacho, Fuji-shi, Shizuoka, 417-8567, Japan

    Tetsuo Kimura

Authors
  1. Kenkichi Michimoto
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  2. Shinsuke Takenaga
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  3. Yo Matsui
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  4. Keitaro Enoki
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  5. Yosuke Nozawa
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  6. Takahiro Higuchi
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  7. Rui Kano
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  8. Tetsuo Kimura
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Contributions

KM: project development, data analysis, manuscript writing. ST: data analysis. YM: data collection. KE: data collection. YN: data collection. TH: data collection. RK: data collection. TK: clinical consult and supervision.

Corresponding author

Correspondence to Kenkichi Michimoto.

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The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the institutional review board of our institution.

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Michimoto, K., Takenaga, S., Matsui, Y. et al. Ectopic origin of bronchial arteries: still a potential pitfall in embolization. Surg Radiol Anat 42, 1293–1298 (2020). https://doi.org/10.1007/s00276-020-02495-7

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  • DOI: https://doi.org/10.1007/s00276-020-02495-7

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