Thoracic aortic dissection associated with bronchial artery embolization：a case report

Thoracic aortic dissection associated with bronchial artery embolization：a case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Thoracic aortic dissection associated with bronchial artery embolization：a case report Jie Yuan, Tian Zhao This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3171100/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Thoracic aortic dissection after bronchial artery embolisation is a rare iatrogenic complication. Here, we report a case of thoracic aortic dissection that occurred after bronchial artery embolisation to improve our understanding of this unusual complication. After the bronchial artery embolisation was successfully performed, the patient was re-admitted the following day due to rapidly increased blood pressure owing to emotional excitement and chest pain the previous afternoon. Computed tomography revealed that the patient had an aortic dissection. The haematoma gradually disappeared after conservative treatment. There was no recurrent haemoptysis, and the aortic dissection had disappeared at the 1-year follow-up. We report a rare case of symptomatic aortic dissection after bronchial artery embolisation. We believe our findings will be useful in the management of similar cases. haemoptysis bronchial artery embolisation complications aortic dissection blood pressure Figures Figure 1 Figure 2 Figure 3 Background Haemoptysis is an alarming symptom that may be life-threatening and can be observed in various inflammatory, infectious, and tumour disorders of the chest. Treatment options include bronchoscopic intervention, medical treatment, surgery, or bronchial artery embolisation (BAE). When the latter is indicated, the interventional radiologist should be aware of adverse reactions and complications. Inadvertent injury to the bronchial arteries during the procedure can result in catastrophic complications such as thoracic aortic dissection (AD). Case Presentation The Human Subjects Research Review Board of our institution approved the interventional protocol. The requirement for patient consent for inclusion in this study was waived. A 63-year-old male was admitted to our hospital on account of chest tightness and shortness for 10 years and aggravated haemoptysis for 9 days. The volume of haemoptysis was significant, approximately 100 mL. The primary condition was emphysema. Enhanced computed tomography angiography (CTA) of the thoracic aorta revealed that one left and one right bronchial artery were slightly enlarged and tortuous(Figs. 1 ). BAE was performed after informed consent was obtained. Catheterisation was performed through the right femoral artery using the Seldinger technique with Philips Allura Xper FD20 DSA. Selective bronchial arteriography was performed using a 5-F catheter (left gastric artery). The left and right culprit bronchial arteries were successfully embolised using a super-selective microcatheter (2.7-Fr Progreat®)(Figs. 2 ). The embolic materials used were PVA particles (350 − 560 µm) and microembolisation coils. The patient experienced emotional activation with a sudden rise in blood pressure (BP) and experienced a mild degree of chest pain the next afternoon. He quarreled with his family members because of family chores and had a maximum BP of 177/72 mmHg. At that time, the pituitary glands continued to function. He suddenly became delirious and did not respond to any irritants 20 min later, presenting with haemodynamic instability and shock; his BP decreased to 58/35 mmHg, and his heart rate was 105 bpm. The patient was transferred to the intensive care unit after emergency tracheal intubation was performed. Electrocardiographic monitoring showed that the BP decreased gradually, heart rate increased rapidly, and the patient had cyanosis. Pericardial effusion was indicated by bedside colour Doppler ultrasonography. The cause of shock was considered to be cardiac tamponade. Pericardiocentesis was performed, and fresh blood was drawn using a drainage tube. Pericardial effusion is caused by the retrograde spread of the haematoma in the AD to the pericardium. Subsequently, the patient's BP pressure increased. Aortic CTA indicated AD (Stanford type A) involving the ascending aorta and extending to the descending aorta (the upper edge of the 11th thoracic vertebra). The location of the intimal rupture was close to the origin of the right bronchial artery (Figs. 3 ). The patient then received symptomatic treatment, including BP and heart rate control medications and antibiotics. The patient was transferred to the general ward for further treatment when his haemodynamic and vital signs were stable. Aortic CTA 10 days later showed that the haematoma had slightly dissipated compared to before, and the location of the intimal tear was closed. The patient was discharged 13 days after his vital signs stabilised, and the pericardial cavity effusion was removed 7 days later. The AD disappeared completely 3 months after CTA. No recurrent haemoptysis was observed during the 1-year follow-up period. Discussion and Conclusions AD is a rarely iatrogenic complication after BAE, Iatrogenic AD in this patient was caused by damage to the intima of the vessel wall during catheterisation, which may be related to poor fixation of the left gastric artery catheter tip and the vessel's stiff wall due to a history of atherosclerosis. Additionally, contrast medium injection with a high-pressure syringe can damage the intima of the aorta, and poor control of the subsequent blood pressure causes this severe complication. This was a case of type A AD and may be related to the location of the intimal rupture of the aortic arch. Based on the patient's vital signs, conservative treatment can be considered, and surgery is always reserved. Specific complications of BAE include chest pain, chest distress, dysphagia, fever, necrosis of the bronchial or aortic walls, pulmonary infarction, bronchial-oesophageal fistulas, and spinal cord infarction. Iatrogenic complications of AD are rarely reported; however, they are likely to present with haemodynamic instability and shock, with an overall mortality rate of 35% 1 . According to reports, the incidence of BAE procedures ranges from 1 − 6.3%, but the actual incidence may be far less than that reported. In the contemporary literature, 12 patients in six articles involving BAE were reported with AD complications during or after the procedure, all of which resolved spontaneously without significant discomfort to the patients. 2–7 However, in this case, the extent of AD caused a pericardial haematocele and subsequent cardiac tamponade, resulting in haemodynamic instability with hypotension or shock, indicating that it is dangerous. To our knowledge, this is the first reported case of symptomatic AD after BAE. The associated predisposing risk factors, clinical presentation, management, and outcomes of iatrogenic AD have not been systematically studied. Among the 723 patients with AD in the International Registry of Aortic Dissection database, 34 (5%) had iatrogenic AD, and 76% were Stanford type A, which is usually the direct sequelae of cardiac surgical procedures. 1 There are no established management guidelines or consensus on whether to continue using vasoconstrictor haemostatic agents, such as the pituitary gland and the corresponding postoperative blood pressure management after BAE. This is because high BP may lead to AD in a patient with a history of atherosclerosis. The choice should be made based on a comprehensive assessment of the primary diseases. Termination of pituitrin can be considered when the BAE procedure is successful, as pituitrin has a remarkable effect on raising BP with related side effects. However, it can objectively evaluate the effect of BAE and determine whether there are any omitted culprit vessels. In conclusion, patients with AD have a low incidence of complications associated with BAE. Therefore, conservative treatments should be considered. Abbreviations BAE bronchial artery embolization AD thoracic aortic dissection CTA Enhanced computed tomography angiography BP blood pressure Declarations Acknowledgements Not applicable. Availability of data and materials Not applicable. Authors’ contributions All authors participated in the design of the case report and coordination, and helped to draft the manuscript. All authors read and approved the final manuscript. Ethics approval and consent to participate Not required. Consent for publication Written informed consent was obtained from patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Competing interests The authors declare that they have no competing interests. References Januzzi JL, Sabatine MS, Eagle KA, Evangelista A, Bruckman D, Fattori R, et al. Iatrogenic aortic dissection. Am J Cardiol. 2002;89:623–6. Mal H, Rullon I, Mellot F, Brugière O, Sleiman C, Menu Y, et al. Immediate and long-term results of bronchial artery embolization for life-threatening hemoptysis. Chest. 1999;115:996–1001. Uflacker R, Kaemmerer A, Picon PD, Rizzon CF, Neves CM, Oliveira ES, et al. Bronchial artery embolization in the management of hemoptysis: technical aspects and long-term results. Radiology. 1985;157:637–44. Kato A, Kudo S, Matsumoto K, Fukahori T, Shimizu T, Uchino A, et al. Bronchial artery embolization for hemoptysis due to benign diseases: immediate and long-term results. Cardiovasc Intervent Radiol. 2000;23:351–7. Hayakawa K, Tanaka F, Torizuka T, Mitsumori M, Okuno Y, Matsui A et al. Bronchial artery embolization for hemoptysis: immediate and long-term results. Cardiovasc Intervent Radiol 1992;15: 154-8; discussion 8–9. Uflacker R, Kaemmerer A, Neves C, Picon PD. Management of massive hemoptysis by bronchial artery embolization. Radiology. 1983;146:627–34. Rocha RD, da Motta-Leal-Filho JM, Galastri FL, Affonso BB, Bogossian H, Nasser F. Self-limiting thoracic aortic dissection during bronchial artery embolization. Radiol Bras. 2017;50:207–8. Januzzi JL, Sabatine MS, Eagle KA, et al. Iatrogenic aortic dissection. Am J Cardiol. 2002;89(5):623–6. Mal H, Rullon I, Mellot F, et al. Immediate and long-term results of bronchial artery embolization for life-threatening hemoptysis. Chest. 1999;115(4):996–1001. Uflacker R, Kaemmerer A, Picon PD, et al. Bronchial artery embolization in the management of hemoptysis: technical aspects and long-term results. Radiology. 1985;157(3):637–44. Kato A, Kudo S, Matsumoto K, et al. Bronchial artery embolization for hemoptysis due to benign diseases: immediate and long-term results. Cardiovasc Interv Radiol. 2000;23(5):351–7. Hayakawa K, Tanaka F, Torizuka T et al. Bronchial artery embolization for hemoptysis: immediate and long-term results. Cardiovascular and interventional radiology . 1992;15(3):154-8; discussion 8–9. Uflacker R, Kaemmerer A, Neves C, Picon PD. Management of massive hemoptysis by bronchial artery embolization. Radiology. 1983;146(3):627–34. Rocha RD, da Motta-Leal-Filho JM, Galastri FL, Affonso BB, Bogossian H, Nasser F. Self-limiting thoracic aortic dissection during bronchial artery embolization. Radiologia brasileira. 2017;50(3):207–8. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3171100","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":219215954,"identity":"3e52c548-bbf4-4968-8486-48bd88d5515e","order_by":0,"name":"Jie Yuan","email":"","orcid":"","institution":"Sir Run Run Shaw Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jie","middleName":"","lastName":"Yuan","suffix":""},{"id":219215957,"identity":"31ab0bc0-e75a-4423-bac7-23255edadc2e","order_by":1,"name":"Tian Zhao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0UlEQVRIiWNgGAWjYBACNvbGBoOEHzY8bPKPDxCnhY/ncEPBw540GX6GtATitMhJpDd8fMB22EayIceASIcxJDZuSOBJ4zE4cObjjTcMdnK6DQS1HGw2SLCw4TE42LvZcg5DsrHZAUJaGBvbDMC2HObdJs3DcCBxG0EtzIztPxLYDvMYHON5RqQWNkZgIAO1SPbwsBGphQeoJbEnjYdfgs3Yco4BEX6Rn//8geGPHzb2bBLMD2+8qbCTI6gFBUjwEBk1yFpI1TEKRsEoGAUjAgAAG4I/0ynlIN8AAAAASUVORK5CYII=","orcid":"","institution":"Sir Run Run Shaw Hospital","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Tian","middleName":"","lastName":"Zhao","suffix":""}],"badges":[],"createdAt":"2023-07-14 15:59:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3171100/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3171100/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":40321853,"identity":"40f82714-3427-42dc-8925-32da00887f7e","added_by":"auto","created_at":"2023-07-20 14:19:40","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":226392,"visible":true,"origin":"","legend":"\u003cp\u003ePreoperative coronal aorta computed tomography angiography (CTA) image showing a slightly enlarged bronchial artery at the beginning of the descending aorta.\u003c/p\u003e","description":"","filename":"1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3171100/v1/89ee1156df1fc931c2040c2f.jpeg"},{"id":40321851,"identity":"797c6597-7bad-409b-81b1-1e6d61237860","added_by":"auto","created_at":"2023-07-20 14:19:40","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":429511,"visible":true,"origin":"","legend":"\u003cp\u003eRight bronchial artery embolised with PVA particles (350−560 μm) and microembolisation coils (3 cm*4 mm, Cook). The post-embolization bronchial arteriography showed that the end of the bronchial artery was occluded, and there was no aortic dissection (AD). Another abnormal left bronchial artery was also successfully embolised (not shown).\u003c/p\u003e","description":"","filename":"2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3171100/v1/1855106c3fc3331e9dae44ee.jpeg"},{"id":40321852,"identity":"c7ad026a-c2fd-4e17-b61b-81b619cec7fd","added_by":"auto","created_at":"2023-07-20 14:19:40","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":570700,"visible":true,"origin":"","legend":"\u003cp\u003eThe day after the bronchial artery embolization procedure, the sagittal and axial aorta CTA images showed a type A AD, an intramural hematoma involving the ascending aorta extending to the descending aorta (to the upper edge of the 11th thoracic vertebra). The location of the intimal rupture was very close to the origination of the right bronchial artery.\u003c/p\u003e","description":"","filename":"3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3171100/v1/7bc78aa28d42c81e77040a45.jpeg"},{"id":41824750,"identity":"4ae93488-cfa6-4cd1-960e-35157ef2cd49","added_by":"auto","created_at":"2023-08-20 09:07:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":508946,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3171100/v1/2986f521-de38-47a0-9a10-91fd52e27d6e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Thoracic aortic dissection associated with bronchial artery embolization：a case report","fulltext":[{"header":"Background","content":"\u003cp\u003eHaemoptysis is an alarming symptom that may be life-threatening and can be observed in various inflammatory, infectious, and tumour disorders of the chest. Treatment options include bronchoscopic intervention, medical treatment, surgery, or bronchial artery embolisation (BAE). When the latter is indicated, the interventional radiologist should be aware of adverse reactions and complications. Inadvertent injury to the bronchial arteries during the procedure can result in catastrophic complications such as thoracic aortic dissection (AD).\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eThe Human Subjects Research Review Board of our institution approved the interventional protocol. The requirement for patient consent for inclusion in this study was waived. A 63-year-old male was admitted to our hospital on account of chest tightness and shortness for 10 years and aggravated haemoptysis for 9 days. The volume of haemoptysis was significant, approximately 100 mL. The primary condition was emphysema. Enhanced computed tomography angiography (CTA) of the thoracic aorta revealed that one left and one right bronchial artery were slightly enlarged and tortuous(Figs.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). BAE was performed after informed consent was obtained. Catheterisation was performed through the right femoral artery using the Seldinger technique with Philips Allura Xper FD20 DSA. Selective bronchial arteriography was performed using a 5-F catheter (left gastric artery). The left and right culprit bronchial arteries were successfully embolised using a super-selective microcatheter (2.7-Fr Progreat\u0026reg;)(Figs.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The embolic materials used were PVA particles (350\u0026thinsp;\u0026minus;\u0026thinsp;560 \u0026micro;m) and microembolisation coils.\u003c/p\u003e \u003cp\u003eThe patient experienced emotional activation with a sudden rise in blood pressure (BP) and experienced a mild degree of chest pain the next afternoon. He quarreled with his family members because of family chores and had a maximum BP of 177/72 mmHg. At that time, the pituitary glands continued to function. He suddenly became delirious and did not respond to any irritants 20 min later, presenting with haemodynamic instability and shock; his BP decreased to 58/35 mmHg, and his heart rate was 105 bpm. The patient was transferred to the intensive care unit after emergency tracheal intubation was performed. Electrocardiographic monitoring showed that the BP decreased gradually, heart rate increased rapidly, and the patient had cyanosis. Pericardial effusion was indicated by bedside colour Doppler ultrasonography.\u003c/p\u003e \u003cp\u003eThe cause of shock was considered to be cardiac tamponade. Pericardiocentesis was performed, and fresh blood was drawn using a drainage tube. Pericardial effusion is caused by the retrograde spread of the haematoma in the AD to the pericardium. Subsequently, the patient's BP pressure increased. Aortic CTA indicated AD (Stanford type A) involving the ascending aorta and extending to the descending aorta (the upper edge of the 11th thoracic vertebra). The location of the intimal rupture was close to the origin of the right bronchial artery (Figs.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The patient then received symptomatic treatment, including BP and heart rate control medications and antibiotics. The patient was transferred to the general ward for further treatment when his haemodynamic and vital signs were stable. Aortic CTA 10 days later showed that the haematoma had slightly dissipated compared to before, and the location of the intimal tear was closed. The patient was discharged 13 days after his vital signs stabilised, and the pericardial cavity effusion was removed 7 days later. The AD disappeared completely 3 months after CTA. No recurrent haemoptysis was observed during the 1-year follow-up period.\u003c/p\u003e"},{"header":"Discussion and Conclusions","content":"\u003cp\u003eAD is a rarely iatrogenic complication after BAE, Iatrogenic AD in this patient was caused by damage to the intima of the vessel wall during catheterisation, which may be related to poor fixation of the left gastric artery catheter tip and the vessel's stiff wall due to a history of atherosclerosis. Additionally, contrast medium injection with a high-pressure syringe can damage the intima of the aorta, and poor control of the subsequent blood pressure causes this severe complication. This was a case of type A AD and may be related to the location of the intimal rupture of the aortic arch. Based on the patient's vital signs, conservative treatment can be considered, and surgery is always reserved. Specific complications of BAE include chest pain, chest distress, dysphagia, fever, necrosis of the bronchial or aortic walls, pulmonary infarction, bronchial-oesophageal fistulas, and spinal cord infarction.\u003c/p\u003e \u003cp\u003eIatrogenic complications of AD are rarely reported; however, they are likely to present with haemodynamic instability and shock, with an overall mortality rate of 35% \u003csup\u003e1\u003c/sup\u003e. According to reports, the incidence of BAE procedures ranges from 1\u0026thinsp;\u0026minus;\u0026thinsp;6.3%, but the actual incidence may be far less than that reported. In the contemporary literature, 12 patients in six articles involving BAE were reported with AD complications during or after the procedure, all of which resolved spontaneously without significant discomfort to the patients.\u003csup\u003e2\u0026ndash;7\u003c/sup\u003e However, in this case, the extent of AD caused a pericardial haematocele and subsequent cardiac tamponade, resulting in haemodynamic instability with hypotension or shock, indicating that it is dangerous. To our knowledge, this is the first reported case of symptomatic AD after BAE. The associated predisposing risk factors, clinical presentation, management, and outcomes of iatrogenic AD have not been systematically studied. Among the 723 patients with AD in the International Registry of Aortic Dissection database, 34 (5%) had iatrogenic AD, and 76% were Stanford type A, which is usually the direct sequelae of cardiac surgical procedures.\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThere are no established management guidelines or consensus on whether to continue using vasoconstrictor haemostatic agents, such as the pituitary gland and the corresponding postoperative blood pressure management after BAE. This is because high BP may lead to AD in a patient with a history of atherosclerosis. The choice should be made based on a comprehensive assessment of the primary diseases. Termination of pituitrin can be considered when the BAE procedure is successful, as pituitrin has a remarkable effect on raising BP with related side effects. However, it can objectively evaluate the effect of BAE and determine whether there are any omitted culprit vessels.\u003c/p\u003e \u003cp\u003eIn conclusion, patients with AD have a low incidence of complications associated with BAE. Therefore, conservative treatments should be considered.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBAE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ebronchial artery embolization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ethoracic aortic dissection\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCTA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEnhanced computed tomography angiography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eblood pressure\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors participated in the design of the case report and coordination, and helped to draft the manuscript. \u0026nbsp; All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot required.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from patient for publication of this case report and any accompanying images. \u0026nbsp; A copy of the written consent is available for review by the Editor-in-Chief of this journal.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eJanuzzi JL, Sabatine MS, Eagle KA, Evangelista A, Bruckman D, Fattori R, et al. Iatrogenic aortic dissection. Am J Cardiol. 2002;89:623\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMal H, Rullon I, Mellot F, Brugi\u0026egrave;re O, Sleiman C, Menu Y, et al. Immediate and long-term results of bronchial artery embolization for life-threatening hemoptysis. Chest. 1999;115:996\u0026ndash;1001.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUflacker R, Kaemmerer A, Picon PD, Rizzon CF, Neves CM, Oliveira ES, et al. Bronchial artery embolization in the management of hemoptysis: technical aspects and long-term results. Radiology. 1985;157:637\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKato A, Kudo S, Matsumoto K, Fukahori T, Shimizu T, Uchino A, et al. Bronchial artery embolization for hemoptysis due to benign diseases: immediate and long-term results. Cardiovasc Intervent Radiol. 2000;23:351\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHayakawa K, Tanaka F, Torizuka T, Mitsumori M, Okuno Y, Matsui A et al. Bronchial artery embolization for hemoptysis: immediate and long-term results. \u003cem\u003eCardiovasc Intervent Radiol\u003c/em\u003e 1992;15: 154-8; discussion 8\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUflacker R, Kaemmerer A, Neves C, Picon PD. Management of massive hemoptysis by bronchial artery embolization. Radiology. 1983;146:627\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRocha RD, da Motta-Leal-Filho JM, Galastri FL, Affonso BB, Bogossian H, Nasser F. Self-limiting thoracic aortic dissection during bronchial artery embolization. Radiol Bras. 2017;50:207\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJanuzzi JL, Sabatine MS, Eagle KA, et al. Iatrogenic aortic dissection. 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Bronchial artery embolization for hemoptysis: immediate and long-term results. \u003cem\u003eCardiovascular and interventional radiology\u003c/em\u003e. 1992;15(3):154-8; discussion 8\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUflacker R, Kaemmerer A, Neves C, Picon PD. Management of massive hemoptysis by bronchial artery embolization. Radiology. 1983;146(3):627\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRocha RD, da Motta-Leal-Filho JM, Galastri FL, Affonso BB, Bogossian H, Nasser F. Self-limiting thoracic aortic dissection during bronchial artery embolization. Radiologia brasileira. 2017;50(3):207\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"haemoptysis, bronchial artery embolisation, complications, aortic dissection, blood pressure","lastPublishedDoi":"10.21203/rs.3.rs-3171100/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3171100/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThoracic aortic dissection after bronchial artery embolisation is a rare iatrogenic complication. Here, we report a case of thoracic aortic dissection that occurred after bronchial artery embolisation to improve our understanding of this unusual complication. After the bronchial artery embolisation was successfully performed, the patient was re-admitted the following day due to rapidly increased blood pressure owing to emotional excitement and chest pain the previous afternoon. Computed tomography revealed that the patient had an aortic dissection. The haematoma gradually disappeared after conservative treatment. There was no recurrent haemoptysis, and the aortic dissection had disappeared at the 1-year follow-up. We report a rare case of symptomatic aortic dissection after bronchial artery embolisation. We believe our findings will be useful in the management of similar cases.\u003c/p\u003e","manuscriptTitle":"Thoracic aortic dissection associated with bronchial artery embolization：a case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-07-20 14:19:35","doi":"10.21203/rs.3.rs-3171100/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"73fa728e-e445-41f0-86a9-85c7bea64d1e","owner":[],"postedDate":"July 20th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-08-20T08:59:24+00:00","versionOfRecord":[],"versionCreatedAt":"2023-07-20 14:19:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3171100","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3171100","identity":"rs-3171100","version":["v1"]},"buildId":"-HB7Z8yhvgn0wM9Nzuekk","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}