Bronchial Artery Embolization (BAE) is a specialized medical procedure designed to address bleeding within the lungs, a condition known as hemoptysis. This minimally invasive technique aims to stop the flow of blood from damaged vessels, primarily the bronchial arteries, which supply oxygenated blood to the lung tissues. BAE offers a minimally invasive alternative to surgery for controlling lung bleeding.
Conditions Addressed by BAE
Hemoptysis, or coughing up blood, can range from mild streaks to severe, life-threatening hemorrhages. Bleeding exceeding 100-500 milliliters per day is considered massive hemoptysis, potentially leading to serious complications like airway obstruction or even drowning.
Hemoptysis has diverse causes, with infections and inflammatory lung diseases being common. Conditions like bronchiectasis (widening of the airways), tuberculosis, fungal infections (e.g., aspergilloma), and lung cancer can all lead to fragile and enlarged bronchial arteries prone to rupture. Doctors consider BAE for recurrent or severe bleeding, especially when scans show abnormally large arteries supplying the lungs. This procedure is often preferred over surgery due to its lower risk profile.
The BAE Procedure Explained
Before the procedure, an evaluation includes a chest X-ray and often a computed tomography (CT) scan to identify the bleeding source and map bronchial artery anatomy. Patients may also undergo bronchoscopy for direct airway visualization. Blood tests assess clotting factors and overall health.
The BAE procedure begins with the patient on an X-ray table. After numbing the skin with a local anesthetic, a small incision is made, often in the groin, to access an artery. A thin, flexible catheter is then inserted into this artery.
Using real-time X-ray guidance (fluoroscopy), the interventional radiologist navigates the catheter through the arterial network towards the bronchial arteries in the chest. A contrast dye is injected through the catheter to make blood vessels visible on X-ray images, allowing precise identification of the bleeding site and abnormal vessels.
The bronchial arteries, which typically originate from the thoracic aorta, supply oxygenated blood to the lungs’ airways and surrounding tissues. Once the specific bleeding vessel is identified, a smaller microcatheter is advanced into it.
Through this microcatheter, specialized embolic agents are injected to block blood flow to the bleeding area. Common materials include permanent polyvinyl alcohol (PVA) particles, temporary gelatin sponge particles, metallic coils, or liquid agents like N-butyl cyanoacrylate (NBCA). These agents are selected based on the bleeding vessel’s characteristics and the underlying cause of hemoptysis.
After embolization, contrast dye confirms the bleeding has stopped. The catheter is then removed, and pressure is applied to the access site. The entire procedure generally takes 0.5 to 3 hours.
What to Expect Afterward
Following BAE, patients are monitored in the hospital, often overnight, and may be discharged the next day. Nursing staff checks vital signs and the incision site for complications. Patients might feel groggy from medications and may experience temporary chest pain or difficulty swallowing, which usually subsides within days or weeks.
Bruising at the catheter insertion site is a common occurrence. While BAE is generally considered safe, there is a small possibility of more serious, though rare, complications. These can include unintended embolization, where the injected material travels to other arteries, potentially affecting areas like the spinal cord. Spinal cord damage, although very rare, could lead to numbness or paralysis. Interventional radiologists take precautions to avoid this by carefully evaluating images for spinal artery connections.
Patients are advised to avoid strenuous activities for about a week after discharge to allow the access site to heal. Instructions will be provided for dressing changes. Follow-up care includes monitoring for bleeding recurrence and further imaging to assess long-term effectiveness. While BAE has a high immediate success rate (77-98%), recurrence can occur due to the underlying disease or if vessels reopen over time.