Successful embolization of bronchial artery aneurysms treatment by embolization with N-butyl-2-cyanoacrylate

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  • Successful embolization of bronchial artery aneurysms

    Dr Elena Lonjedo Vicent, MD. Prof. Interventional and Vascular Unit Universitary Hospital Dr Peset Valencia

  • Disclosure

    Speaker name:

    DR Elena Lonjedo

    I have the following potential conflicts of interest to report:

    Consulting

    Employment in industry

    Stockholder of a healthcare company

    Owner of a healthcare company

    Other(s)

    I do not have any potential conflict of interest

    X

    X

  • Mediastinal bronchial artery aneurysms (BAA) are uncommon, with fewer than 50 published case reports. They are identified in

  • Clinical presentation

     Clinical presentation varies from an incidental finding to hemoptysis or hemomediastinum and shock resulting from rupture.

     Extrapulmonary bronchial aneurysm manifests as a spontaneous mediastinal hematoma that presents with severe retrosternal pain resembling an acute coronary syndrome or aortic dissection.

     Intrapulmonary aneurysms manifests as intermittent or massive hemoptysis

  • Ethiology

    Many predisposing conditions have been described in the setting of BAA including bronchiectasis, atherosclerosis trauma, radiation therapy, mycotic infection and Osler-Weber- Rendu syndrome. This suggests that the etiology of these aneurysms may be related to the chronic inflammatory state or to the hyperafflux of the vessels involved

  • Diagnosis AngioTc is the diagnostic method of choice,

    relegating arteriography for diagnostic confirmation and treatment.

    Xray film Ct

    MRI Arteriography

  • TREATMENT

    Treatment may be surgical, with graft stent or transarterial embolization

  • CASE 1 54-year-old man Clinical history of an infected bronchiectasis

    AngioTC:aneurysm at the origin of the left bronchial artery (20x14 mm)

  • CASE 1

    Transarterial embolization with steel coils

  • 3 months Follow up: complete occlusion of aneurysm

    CASE 1

  • 81 years-old-man

    ●Medical history of chronic bronchitis

    ●Bilateral upper lobe bronchiectasis with episodes of hemoptysis

    ●Currently presented to our emergency department with fever, pleuritic chest

    pain, productive cough, and an elevated WBC

    CASE 2

  • CASE 2

    AngioTC: mediastinal window showed a 12 mm aneurysm proximal to the origin of an hypertrophic left bronchial artery, with a significant stenosis proximal to the aneurysm

    AngioTC: lung window showed a change of chronic bronchitis and bilateral cystic bronchiectasis

  • CASE 2

    Transarterial embolization with Onyx

  • Discussion

    Rare disease

    There is currently an increse in incidence as a casual finding in CT images

    It is important to treat the injury before it breaks, specially in mediastinal

    aneurysm.

    Endovascular embolization seems to be the best therapeutical option

    Depending on the neck, the caliber of the vessel , the stability of the

    catheter we used different embolizing agents

  • Conclusion:

    We present two cases of bronchial

    aneurysms treated with embolization

    with good clinical and morphological

    outcome with detachable coils and

    with onyx without complications.

  • References:

    1. Tanaka K, Ihaya A, Horiuci 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

    2. Misselt AJ, Krowka MJ, Misra S. Successful Coil Embolization of Mediastinal Bronchial Artery Aneurysm. Journal of

    vascular and interventional radiology : JVIR. 2010;21(2):295-296. doi:10.1016/j.jvir.2009.10.030.

    3. M. Pugnale, F. Portier, A. Lamarre, et al. Hemomediastinum caused by rupture of a bronchial artery aneurysm: successful

    treatment by embolization with N-butyl-2-cyanoacrylate. J Vasc Interv Radiol, 12 (2001), pp. 1351–1352

    4. E. Sanchez, P. Alados, L. Zurera, et al. Bronchial artery aneurysm treated with aortic stent graft and fibrin sealant Ann

    Thorac Surg, 83 (2007), pp. 693–695

    5. Lin J, Wood DE. Bronchial artery aneurysm refractory to transcatheter embolization. Ann Thorac Surg 2008; 86: 306-8.

    6. Mizuguchi S, Inoue K, Kida A, Isota M, Hige K, Aoyama T, et al. Ruptured bronchial artery aneurysm associated with

    bronchiectasis: a case report. Ann Thorac Cardiovasc Surg. 2009;15:115-8.

    7. Quero-Valenzuela F, Piedra-Fernández I, Sevilla-López S, Cueto-Ladrón de Guevara A. Interact Cardiovasc Thorac Surg.

    2011 Apr;12(4):619-21

    8. Tsolaki E, Salviato E, Coen M, et al. Double right bronchial artery aneurysm treated with combined procedures. Eur J Vasc

    Endovasc Surg 2007;34:537–9.

    9. Rognoni A, Lupi A, Rosso R, et al. Giant bronchial artery aneurysm treated by coil embolization and Amplatzer placement.

    J Cardiovasc Med (Hagerstown) 2015;16(suppl 1):S66–7.

    10. Zhang LJ, Yang GF, Lu GM. Noninvasive diagnosis of bronchial artery aneurysm using dual-source computed tomography

    angiography. Acta Radiol 2008;49:291–4

    11. Do KH, Goo JM, Im JG, Kim KW, Chung JW, Park JH. Systemic arterial supply to the lungs in adults: spiral CT findings.

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    12. Yonemitsu T. et al. . Evaluation of transcatheter arterial embolization with gelatin sponge particles, microcoils, and n-butyl

    cyanoacrylate for acute arterial bleeding in a coagulopathic condition. J Vasc Interv Radiol 20, 1176–1187 (2009)

  • Successful embolization of bronchial artery aneurysms

    Dr Elena Lonjedo Vicent, MD. Prof. Interventional and Vascular Unit Universitary Hospital Dr Peset Valencia