successful embolization of bronchial artery aneurysms · treatment by embolization with...
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Successful embolization of bronchial artery aneurysms
Dr Elena Lonjedo Vicent, MD. Prof.Interventional and Vascular UnitUniversitary 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
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Mediastinal bronchial artery aneurysms (BAA) are uncommon, with fewer than 50 published case reports.They are identified in <1% of bronchial selective arteriograms.They are anatomically classified into mediastinal or extrapulmonary and intrapulmonary
Mediastinal Bronquial Artery Aneurysm: anuncommon patology.
Transarterial Embolization Treatment
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 beendescribed in the setting of BAA includingbronchiectasis, atherosclerosis trauma, radiationtherapy, mycotic infection and Osler-Weber-Rendu syndrome.This suggests that the etiology of theseaneurysms may be related to the chronicinflammatory state or to the hyperafflux of thevessels involved
DiagnosisAngioTc is the diagnostic method of choice,
relegating arteriography for diagnostic confirmationand treatment.
Xray filmCt
MRIArteriography
TREATMENT
Treatment may be surgical, with graftstent or transarterial embolization
CASE 154-year-old manClinical 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:
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a case report and review of 26 cases from literature. J Vasc Surg 2003;38:1125–9
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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
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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.
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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
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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 UnitUniversitary Hospital Dr Peset Valencia
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