Bronchial Artery Embolization (BAE) is a specialized, minimally invasive procedure performed by interventional radiologists to stop severe or recurrent bleeding originating from the lungs. This technique treats hemoptysis, the medical term for coughing up blood. BAE uses catheter-based technology and advanced imaging to locate the source of the bleeding and block the offending blood vessel from the inside. The procedure provides a rapid method to stabilize patients facing potentially life-threatening blood loss.
Understanding the Purpose of BAE
BAE is performed to treat moderate to massive hemoptysis, defined as coughing up 200 to 600 milliliters of blood over 24 hours. This level of bleeding is dangerous due to the blood loss and the risk of airway obstruction or aspiration. The source of this severe bleeding usually stems from the bronchial arteries, which are part of the systemic circulation and carry blood at high pressure.
Bronchial arteries become abnormally enlarged in response to chronic inflammatory lung diseases, such as tuberculosis, bronchiectasis, or cystic fibrosis. These high-pressure systemic arteries develop fragile connections near the lung tissues, which can rupture and cause profuse bleeding into the airways. The goal of BAE is to selectively target and occlude these abnormal vessels, controlling the hemorrhage while preserving the function of the main pulmonary arteries.
BAE is considered the first-line treatment for hemoptysis because it is less traumatic than open-chest surgery, which carries a higher risk of complications and mortality. Stopping the bleeding stabilizes the patient and allows time for the underlying lung condition to be managed. The success rate of immediate bleeding control with BAE is high, often exceeding 90%.
Preparing for the Procedure
Preparation for BAE begins with a diagnostic workup to confirm the bleeding source and ensure patient safety. Physicians order a high-resolution computed tomography (CT) scan of the chest, often with intravenous contrast. This imaging helps visualize the abnormal, enlarged bronchial arteries and maps the complex vascular anatomy before the catheter is inserted.
Patients must stop taking blood-thinning medications, such as anticoagulants or antiplatelet drugs, several days before the procedure to minimize bleeding risk at the insertion site. Standard laboratory blood tests assess kidney function, clotting ability, and overall blood count. Fasting is also necessary before the procedure to reduce the risk of complications if sedation is required.
Informed consent is a formal process where the interventional radiologist explains the procedure, its benefits, and the associated risks, including rare neurological complications. A baseline neurological examination is conducted and recorded before the procedure, providing a reference point for post-procedure monitoring.
The Procedure Walkthrough
The BAE procedure is conducted in an angiography suite equipped with real-time X-ray imaging, known as fluoroscopy. The patient is positioned on the table, and the access site, typically the femoral artery in the groin, is sterilized. Local anesthesia is administered, and moderate sedation is often given to help the patient remain comfortable during the intervention, which can take one to three hours.
A small needle punctures the femoral artery, and a thin wire is threaded through it to introduce a catheter, a narrow, flexible tube. Using fluoroscopic guidance, the radiologist navigates the catheter through the aorta until the tip reaches the origin of the bronchial arteries in the chest.
Once the main bronchial artery is reached, contrast dye is injected, and X-ray images are taken in a process called angiography. This visualization highlights abnormal vessels, revealing signs of bleeding such as vessel enlargement, tortuosity, and abnormal connections (shunts). The radiologist must identify the precise bleeding vessel and ensure that no non-target vessels, such as arteries supplying the spinal cord, are inadvertently visualized.
To proceed, a smaller microcatheter is advanced through the main catheter and placed near the bleeding point. The radiologist injects an embolic agent, such as fine particles (polyvinyl alcohol or microspheres) or metallic coils, to physically block blood flow within the vessel. These agents are chosen based on vessel size and the need for temporary or permanent occlusion. After deployment, a final injection of contrast confirms the successful blockage, and the catheters are removed, with manual pressure applied to the groin site.
Recovery and Managing Risks
Following BAE, the patient is moved to a recovery area for monitoring of blood pressure, heart rate, and the catheter insertion site. Patients must remain lying flat for several hours to allow the artery puncture site to seal effectively and prevent hematoma formation. The hospital stay is usually brief, with most patients kept overnight for observation and discharged the following day.
In the immediate aftermath, patients commonly experience transient chest or back pain, resulting from the sudden lack of blood flow to the blocked artery. Another frequent, temporary side effect is difficulty or pain when swallowing (dysphagia), which occurs if the embolized artery shared a small branch with the esophageal blood supply. These symptoms are managed with standard pain medication and usually resolve within a few days.
A serious, though rare, risk of BAE is non-target embolization, where embolic agents mistakenly travel into an unintended artery. The most severe complication is the inadvertent blocking of the anterior spinal artery, which can lead to spinal cord ischemia, resulting in neurological deficits or paralysis. Clinicians mitigate this risk by using highly precise microcatheters and avoiding embolization when the spinal artery is visualized during angiography. Close post-procedure neurological assessments are performed to quickly identify and manage this complication.