bronchial artery embolization

Question 1

recommended particle size for bronchial artery embolization

Answer 1

500-700 micron

Question 2

what size particle theoretically ensures no significant shunting from bronchial artery to Pulmonary artery or pulmonary vein

Answer 2

particles greater than 300 micron

Question 3

bronchial artery embolization patients prone to re-hemorrhage

Answer 3

infectious and neoplastic etiologies are prone to re-hemorrhage

Question 4

most common bronchial artery patterns

Answer 4

1. right intercostal-bronchial trunk from right posterolateral surface of aorta
2. left bronchial artery from left anterolateral surface of aorta
3. common right and left bronchial artery trunk from anterior surface of aorta

Question 5

classic findings with bronchial artery bleeding

Answer 5

1. enlargement of the main artery (>2mm)
2. hypervascularity
3. parenchymal stain
4. bronchial to pulmonary artery shunting

Question 6

percent of patients that suffer recurrent bleeding after bronchial artery embolization

Answer 6

• 20-30% suffer re-bleeding after bronchial artery embo

Question 7

causes of re-bleeding after bronchial artery embolization

Answer 7

1. incomplete initial embo
2. recruitment of collateral vessels
3. recanalization of embolized vessels
4. unidentified bleeding arteries
5. progression

Question 8

most common complications after bronchial artery embo

Answer 8

1. post-embolization syndrome
2. non-target embolization
3. bronchial or esophageal necrosis
4. pulmonary infarction (if pulmonary artery or branch is occluded)
5. transverse myelitis from inadvertent embolization of the anterior spinal artery (most dreaded)

Question 9

potential sources of non-bronchial collaterals that should be interrogated during a bronchial artery embolization

Answer 9

1. internal thoracic (mammary) artery
2. thyrocervical branch of the subclavian
3. lateral branches of the subclavian or axillary artery
4. intercostals
5. inferior phrenic

Question 10

definition of massive hemoptysis

Answer 10

more than 300 mL/24 hrs
three or more episodes in 1 week of >100 mL
chronic or slowly increasing episodes

Question 11

do patients with primary and metastatic cancer to the lung who present with bronchial bleeding often have hypertrophied bronchial arteries?

Answer 11

no - the bronchial arteries are often not hypertrophied in these patients

Question 12

most common branching pattern of the bronchial arteries

Answer 12

Two arteries on the left and one on the right arising from an intercostobronchial trunk in 40%

Question 13

typical T spine origin of the bronchial artries

Answer 13

T5-T6

Question 14

The incidence of spinal artery ischemia from bronchial artery embolization

Answer 14

between 1.4-6.5%

Question 15

what size particles are considered to be too large to pass into the spinal artery

Answer 15

Greater than 350 micron may decrease the risk of nontarget embolization because the particles are considered to be too large to pass into the small spinal artery