Endovascular treatment of ectopic bronchial artery aneurysm with brachiocephalic artery stent placement and coil embolization

Abstract

Background:Bronchial artery aneurysm (BAA) is an uncommon but potentially life-threatening disease, and multiple BAAs are even rarer. Clinically, the tortuous and short neck of a BAA may present significant challenges for invasive intervention.Methods:This report describes the detailed process of diagnosis and treatment and includes a literature review of the etiology, clinical presentation, and therapeutic management of BAA.Results:A rare case of multiple BAAs, with one having an inflow artery arising from the brachiocephalic trunk, was referred to our hospital. The patient was successfully treated with coil embolization and brachiocephalic artery stent placement. In addition, we conducted a literature review involving 63 cases of BAA. BAA was most commonly associated with bronchiectasis and was located predominantly in the mediastinum. There was no significant difference between the diameters of the ruptured aneurysms and those of the nonruptured aneurysms (P = 0.115). Transcatheter arterial embolization was the most commonly adopted technique to treat BAA, while thoracic aortic endovascular repair was selected if the neck between the aneurysm and the aorta was short. Subgroup analysis suggested that patients with > 1 BAA were significantly more likely to be female than male (χ2 test, P = 0.034).Conclusion:Transcatheter coil embolization combined with stent placement could be a reasonable treatment option for BAAs with a tortuous and short neck. According to our literature review, patients with multiple BAAs display distinctive clinical characteristics compared with patients with a single BAA.

A ruptured bronchial artery aneurysm with massive haemoptysis

“…In this case, the diameter of BAA (3 mm) was much smaller than the previously reported mean diameter of 29.3 mm for ruptured BAAs 5. At the first session of BAG, BAA was regarded as torsion of the bronchial artery because of its small size.…”

A Ruptured Mediastinal Bronchial Artery Aneurysm Treated with Urgent Thoracic Endovascular Aortic Repair

“…The etiology of BAAs is uncertain, but an increased blood flow of the bronchial artery might contribute to the formation of an aneurysm (1, 3). Bronchiectasis, hypertension, arteriosclerosis, chronic obstructive pulmonary disease, tuberculosis, and trauma have been reported as typical risk factors for BAA (1)(2)(3). In our case, a lung CT scan on admission showed bronchiectasis as a possible cause of the BAA.…”

“…Bronchial artery aneurysm (BAA) is a rare disease, but it can cause severely disturbed hemodynamics when it ruptures (1). Conventionally, transcatheter bronchial artery embolization (TAE) or open chest surgery is conducted to isolate the aneurysm.…”

Open surgical correction of multiple bronchial artery aneurysms

“…TAE has, therefore, been proposed as a less invasive approach, consisting of occlusion of the afferent and efferent arterioles using gelatin sponges, detachable coils, steel coils, occlusion balloons, stent‐grafts, or N ‐butyl‐2‐cyanoacrylate [20]. These procedures are, however, potentially unsuccessful, especially in patients with tortuous arteries and insufficient landing zones for endovascular materials, and hemoptysis has been reported to eventually recur due to enhancement of the aneurysm by collateral arteries, requiring reintervention 12 . Risks and benefits of both treatment options should, therefore, be well‐considered, and choices should be made within the perspective of the individual patients and anatomical characteristics.…”