Bronchial artery embolisation BAE

This was first reported by Remy and colleagues in 197731 and is increasingly used in the management of life threatening haemoptysis.20 The procedure involves the initial identification of the bleeding vessel by selective bronchial artery cannula-tion, and the subsequent injection of particles (polyvinyl alcohol foam, isobutyl-2-cyanoacrylate, Gianturco steel coils or absorbable gelatin pledgets) into the feeding vessel (fig 22.2). A number of features provide clues to the bronchial artery as the source of bleeding, including the infrequent identification of extravasated dye or the visualisation of tortuous vessels of increased calibre or aneurysmal dilatation.32 The immediate success rates for control of massive haemoptysis is excellent, ranging from 64% to 100%, although recurrent non-massive bleeding has been reported in 16-46% of patients.32-35 Technical failure of BAE occurs in up to 13% of cases and is largely caused by non-bronchial artery collaterals from systemic vessels such as the phrenic, intercostal, mammary, or subclavian arteries.35 Complications of BAE include vessel perforation,

Figure 22.3 Algorithm for management of massive haemoptysis. *Palliative measures may be appropriate in the setting of advanced malignancy.

intimal tears, chest pain, pyrexia, haemoptysis, systemic embolisation, and neurological complications. When the anterior spinal artery is identified as originating from the bronchial artery, embolisation is often deferred owing to the risk of infarction and paraparesis.32 The development and

application of coaxial microcatheter systems allows more selective catheterisation and embolisation of branches of the bronchial arteries, thereby reducing the risk of occluding branches such as the anterior spinal artery.34

Ventilation t Suction in

Ventilation t Suction in

positioned in the left main bronchus to ventilate the left lung and the tracheal lumen is positioned above the carina, allowing ventilation of the right lung while preventing occlusion of the right upper lobe orifice.
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