Advertisement

CardioVascular and Interventional Radiology

, Volume 41, Issue 8, pp 1267–1273 | Cite as

A Stepwise Embolization Strategy for a Bronchial Arterial Aneurysm: Proximal Coil and Distal Glue with the Optional Use of a Microballoon Occlusion System

  • Takahiko MineEmail author
  • Tomohiro Matsumoto
  • Toshihiko Hayashi
  • Kosuke Tomita
  • Kimihiko Masuda
  • Masahiro Kawashima
  • Fumio Sakamaki
  • Terumitsu Hasebe
Technical Note

Abstract

Purpose

This study aimed to demonstrate a transcatheter embolization strategy for bronchial artery aneurysms (BAAs) using coils for the proximal lesion and glue (n-butyl-2-cyanoacrylate [NBCA]) embolization for the distal lesion with or without the use of a microballoon occlusion catheter.

Materials and Methods

Five patients with BAAs presenting with hemoptysis were enrolled in this study. A bronchial angiogram indicated a mediastinal BAA near the orifice, accompanied by dilated distal branches with or without intrapulmonary BAA. A stepwise procedure was performed. First, the intrapulmonary branches were embolized with glue, with or without the use of a microballoon catheter depending upon the anatomical and local flow hemodynamic conditions. Second, the mediastinal BAA was tightly packed with detachable coils.

Results

Glue embolization of intrapulmonary abnormal branches successfully controlled hemoptysis in all patients; microballoon catheters were used in five of the 10 arteries. The volume embolization ratio of coils within the mediastinal BAA ranged from 28 to 59%, and neither coil compaction nor signs of recanalization were observed during follow-up.

Conclusion

The stepwise embolization procedure with the sequential use of glue (with or without a microballoon occlusion system) and detachable coils may represent a possible endovascular strategy for the treatment of complex BAAs.

Level of Evidence IV

Level 4: Case Series.

Keywords

Bronchial arterial aneurysm Hemoptysis Bronchial arterial embolization n-Butyl cyanoacrylate Detachable coil 

Notes

Compliance with Ethical Standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest associated with this study.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed Consent

Written informed consent was obtained from all individual participants included in this study.

Supplementary material

Video 1. B-glue for intrapulmonary bronchial artery aneurysms (BAA). The BAA and the parent vessel were filled with a glue cast. (MP4 19616 kb)

References

  1. 1.
    Tanaka K, Ihaya A, Horiuci T, Morioka K, Kimura T, Uesaka T, et al. Giant mediastinal bronchial artery aneurysm mimicking benign esophageal tumor: a case report and review of 26 cases from literature. J Vasc Surg. 2003;38:1125–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Lü PH, Wang LF, Su YS, Lee DH, Wang SX, Sun L, et al. Endovascular therapy of bronchial artery aneurysm: five cases with six aneurysms. Cardiovasc Interv Radiol. 2011;34:508–12.CrossRefGoogle Scholar
  3. 3.
    Hamaguchi S, Lohman BD, Ogawa Y, Arai Y, Hashimoto K, Matsumoto J, et al. Preliminary findings of arterial embolization with balloon-occluded and flow-dependent histoacryl glue embolization in a swine model. Jpn J Radiol. 2015;33:344–51.CrossRefPubMedGoogle Scholar
  4. 4.
    Shimohira M, Hashimoto T, Abematsu S, Hashizume T, Nakagawa M, Ozawa Y, et al. Triaxial system in bronchial arterial embolization for haemoptysis using N-butyl-2-cyanoacrylate. Br J Radiol. 2015;88:20150265.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Zhang Y, Xing X, Shen X, Zhu X. The volume embolization ratio of intraaneurysmal embolization using guglielmi detachable coils. Turk Neurosurg. 2015;25:866–72.PubMedGoogle Scholar
  6. 6.
    Yasumoto T, Osuga K, Yamamoto H, Ono Y, Masada M, Mikami K, et al. Long-term outcomes of coil packing for visceral aneurysms: correlation between packing density and incidence of coil compaction or recanalization. J Vasc Interv Radiol. 2013;24:1798–807.CrossRefPubMedGoogle Scholar
  7. 7.
    Sancho C, Domínguez J, Escalante E, Hernandez E, Cairols M, Martinez X. Embolization of an anomalous bronchial artery aneurysm in a patient with agenesis of the left pulmonary artery. J Vasc Interv Radiol. 1999;10:1122–6.CrossRefPubMedGoogle Scholar
  8. 8.
    Hoffmann V, Ysebaert D, De Schepper A, Colpaert C, Jorens P. Acute superior vena cava obstruction after rupture of a bronchial artery aneurysm. Chest. 1996;110:1356–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Shaer AH, Bashist B. Computed tomography of bronchial artery aneurysm with erosion into the esophagus. J Comput Assist Tomogr. 1989;13:1069–71.CrossRefPubMedGoogle Scholar
  10. 10.
    Nakamura R, Inage Y, Tsuchiya A, Kato T, Yuzawa K, Ueki H, et al. Bronchial artery aneurysm treated with video-assisted thoracoscopic surgery. Ann Vasc Surg. 2014;28:1321.e1-3.CrossRefPubMedGoogle Scholar
  11. 11.
    Tsolaki E, Salviato E, Coen M, Galeotti R, Mascoli F. Double right bronchial artery aneurysm treated with combined procedures. Eur J Vasc Endovasc Surg. 2007;34(5):537–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Goh Y, Rajendran PC, Loh SEK, Choong AMTL, Ng SJK, Wee B. Transcatheter embolization of a large mediastinal bronchial artery aneurysm with short neck. ANZ J Surg. 2017;9:1 [Epub ahead of print].Google Scholar
  13. 13.
    Iida Y, Saguchi T, Ikeda N, Ogino H. Bronchial artery aneurysm. J Vasc Surg. 2013;58:217.CrossRefPubMedGoogle Scholar
  14. 14.
    Samura M, Morikage N, Yamashita O, Murakami M, Suehiro K, Hamano K. Combination of aortic stent grafting and arterial embolization for bronchial artery aneurysm associated with bronchial-pulmonary arterial fistula. J Vasc Interv Radiol. 2015;26:1077–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Baltacioğlu F, Cimşit NC, Bostanci K, Yüksel M, Kodalli N. Transarterial microcatheter glue embolization of the bronchial artery for life-threatening hemoptysis: technical and clinical results. Eur J Radiol. 2010;73:380–4.CrossRefPubMedGoogle Scholar
  16. 16.
    Mine T, Murata S, Nakazawa K, Onozawa S, Ueda T, Kumita S, et al. Glue embolization for gastroduodenal ulcer bleeding: contribution to hemodynamics and healing process. Acta Radiol. 2013;54:934–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Woo S, Yoon CJ, Chung JW, Kang SG, Jae HJ, Kim HC, et al. Bronchial artery embolization to control hemoptysis: comparison of N-butyl-2-cyanoacrylate and polyvinyl alcohol particles. Radiology. 2013;269:594–602.CrossRefPubMedGoogle Scholar
  18. 18.
    Ikoma A, Kawai N, Sato M, Tanaka T, Sonomura T, Sahara S, et al. Pathologic evaluation of damage to bronchial artery, bronchial wall, and pulmonary parenchyma after bronchial artery embolization with N-butyl cyanoacrylate for massive hemoptysis. J Vasc Interv Radiol. 2011;22:1212–5.CrossRefPubMedGoogle Scholar
  19. 19.
    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;22:1395–409.CrossRefPubMedGoogle Scholar
  20. 20.
    Matsumoto T, Hasebe T, Endo J, Hashida K, Ichikawa H, Kojima S, et al. Balloon-occluded transarterial chemoembolization using a 1.8-French tip coaxial microballoon catheter for hepatocellular carcinoma: technical and safety considerations. Minim Invasive Ther Allied Technol. 2015;24:94–100.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018

Authors and Affiliations

  1. 1.Department of RadiologyNippon Medical School Chiba Hokusoh HospitalInzaiJapan
  2. 2.Department of Radiology, Tokai University Hachioji HospitalTokai University School of MedicineHachiojiJapan
  3. 3.Department of Respiratory MedicineNational Hospital Organization Tokyo National HospitalKiyoseJapan
  4. 4.Department of Respiratory Medicine, Tokai University Hachioji HospitalTokai University School of MedicineHachiojiJapan

Personalised recommendations