Evaluation of Selective Bronchial Artery Embolization Utilizing "New" Minicoils and Infusion Catheter Set for Management of Recurrent Hemoptysis

Abstract

A selective bronchial artery embolization (S-BAE) utilizing a "new" minicoil and infusion catheter set (ICS) was employed in two patients with repeated hemoptysis. Bronchial arteriography (BAG) was carried out using the Seldinger technique. A6.5 F normal diagnostic catheter with tapered tip was inserted and positioned in the thoracic aorta. A search was made to selectively enter the bronchial arteries on the affected side. The initial diagnostic arteriogram in two patients showed the common trunk with the right bronchial and the 2nd-3rd intercostal arteries. This arteriogram showed hypervascularity and a shunting pattern to right pulmonary vessels originated from the bronchial artery. A S-BAE was carried out using a "new" minicoil and ICS. The ICS consists of a strait thin-wall Teflon catheter (3F) and a stainless steel guide wire (0.025 inch). The ICS was inserted into a 6.5 F diagnostic catheter and was pushed until it arrived at the right bronchial artery forming the common trunk with the intercostal artery. The steel guide wire was then pulled out from the Teflon catheter. The second diagnostic arteriogram was taken for confirmation of the Teflon catheter selectively positioned in the right bronchial artery. The right bronchial artery was selectively embolized by transporting "new" minicoils through the Teflon catheter by pushing steel guide wire. Several disadvantages of BAE using Gelfoam as a vascular occlusive agent have been reported. (1) Spinal arteries have communication with the bronchial arteries through the intercostal trunk in about 5% of patients, and this communication is more common on the right side. The embolization of the right intercostobronchial trunk using Gelfoam has the possibility of injury in the spinal cord. (2) The catheter tip may recoil from the selective position during repeated injection of the small cubes of Gelfoam through the standard angiographic catheter. Such recoil of the catheter eventually leads to peripheral embolization. (3) Embolization using Gelfoam is only a palliative treatment because recanalization may occur due to reab sorption of the occlusive agent. These three drawbacks can be overcome with when using our S-BAE technique. Our S-BAE technique, which not only saves time but also eliminates the possibility of displacement of the catheter, is especially excellent in the occlusion of the right bronchial artery forming the common trunk with the intercostal artery.