A Stepwise Embolization Strategy for a Bronchial Arterial Aneurysm: Proximal Coil and Distal Glue with the Optional Use of a Microballoon Occlusion System
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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.
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.
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.
KeywordsBronchial arterial aneurysm Hemoptysis Bronchial arterial embolization n-Butyl cyanoacrylate Detachable coil
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.
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.
Written informed consent was obtained from all individual participants included in this study.
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)
- 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
- 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
- 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