Embolization of bronchial arteries: Single center experiences

Embolization of bronchial arteries: Single center experiences | 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 Research Article Embolization of bronchial arteries: Single center experiences Igor Sekulić, Nemanja Rančić, Uroš Miladinović, Aleksandar Jovanovski, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6574276/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background/Aim The most common indications for bronchial-artery embolisation are massive hemoptysis. The aim of our study was to present the basic characteristics of patients who underwent bronchial-artery embolisation and to point out the great importance of this therapeutic method. Methods It is a single-center retrospective cross-sectional study, which included all patients who underwent embolization in the period from June 2007 to October 2023 due to hemoptysis. Results The total number of patients in our study was 192, with average amount of coughed up blood that was 100 ml. In ratio 6:4 (respectively), we performed bronchial-artery embolisation in men and women. The average age was 59 years. Based on bronchoscopy, multidetector computed tomography findings or selective angiography, it was determined that the cause of hemoptysis in 65.1% patients was on the right, in 31.8% on the left, and in 3.1% the cause of hemoptysis was bilateral. Bronchial arteries dilatation (diameter above 2 mm) existed in 52.6% patients. Pathological network of blood vessels was verified in 27.6% patients. In approximately three quarters of the patients (76.6%), we used coils as an embolizing agent, to avoid the possibility of embolization of the systemic circulation due to frequent existence of pathological arteriovenous communication, so we had no complications. Embolizing beads were used in 23.4% of patients. The average number of coils consumed per patient was two. In 87.0% patients we performed single intervention, while 13.0% needed reintervention. Conclusions The bronchial-artery embolisation is an effective endovascular method for the care of patients with massive hemoptysis, comfortable for the patient, with minimal risk. Using coils as an embolization agent is a more effective and safer method, compared to embolization particles or liquid agents. bronchial arteries embolization massive hemoptysis interventional vascular radiology multidetector computed tomography supraselective angiography Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Bronchial arteries (BAs) are nutritional blood vessels of structures in the chest, of small caliber up to 2 mm on the ostium and, under normal physiological conditions, do not participate in gas exchange [ 1 , 2 ]. There are usually two BAs for the left lung and one for the right. In a study of 150 cadavers Cauldwell et al. studied the anatomical variations of the origin of BAs, in the case when they started directly from thoracic aorta [ 3 ] and based on that they defined four anatomical variants of BAs (Fig. 1 ). Indications for BAs embolization (BAE) are massive hemoptysis, as bleeding from BAs is the cause of massive hemoptysis in about 90% of cases [ 4 ]. In 5% of cases bleeding originates from the pulmonary arteries, and in the remaining 5% either from the aorta (tracheobronchial fistula, ruptured aneurysm) or from other systemic arteries [ 4 – 6 ]. Non-treatment of massive and recurrent hemoptysis is associated with a mortality rate between 9% and 38% [ 7 ]. Causes of massive hemoptysis are most common: bronchiectasis, neoplasms, arteriovenous malformations (AVM), aspergillosis, tuberculosis, etc [ 8 ]. Chest X-ray, bronchoscopy and chest multidetector computed tomography (MDCT) are recommended diagnostic procedures before intervention [ 9 ]. Blood vessel embolization is an endovascular method of interventional vascular radiology, which in a safe and patient-friendly way enables therapeutic occlusion of blood vessels and thus stopping of bleeding. The aim of our study was to present the basic characteristics of patients who underwent bronchial artery embolization and to point out the great importance of this therapeutic method. Methods It is a single-center retrospective cross-sectional study, which included all patients who underwent embolization, in the period from June 2007 to October 2023 due to hemoptysis and usually after verification of altered bronchial arteries. After bronchoscopy and/or MDCT aortography, (Fig. 1 a and 1 b) patients were referred to BAE to the Angio Room ( Siemens® Artis Zee , Germany), at the Department of Interventional Vascular Radiology, Institute of Radiology, Military Medical Academy (MMA), Belgrade. Selective BAs angiography was performed, mainly by right transfemoral approach and Seldinger's method (Fig. 2 a). Of the diagnostic catheters, the most commonly used were H1H, then the left coronary catheter, SIM I or SIM II (depending on the diameter of the aorta), Cobra, etc ( TERUMO Interventional Systems , USA). If we were not able to find BAs in the places of the most common expected ostium, we resorted to aortography, Pigtail catheter. Then with a microchateter Prograte™ ( TERUMO Interventional Systems , USA) we entered deeper into the artery, either to possibly avoid the Adamkiewitz artery (if it is a right BA), or to supraselectively enter the artery, which needed to be embolized (Fig. 2 b). After supraselective angiography, embolization was performed. BAE can be performed with embolizing beads or coils [ 10 , 11 ]. We opted mainly for embolization coils ( Azur hydrocoil ™, TERUMO Interventional Systems , USA), due to the frequent existence of pathological AV communications, and the possibility of embolization of the systemic circulation. After embolization, we checked the exclusion of pathologically altered blood vessels from the circulation on control selective / supraselective angiography (Fig. 3 ). Descriptive statistical analysis was performed, so all values ​​were presented either in the form of an average value with standard deviation if it was a normal data distribution or in the form of a median with an interquartile range (25-75th percentile) if it was not normally distributed data. Distribution was verified by the Kolmogorov-Smirnov test. Attribute variables were presented in the form of frequencies of individual categories. Statistical analysis was performed in the statistical program IBM SPSS version 26.0. Results The total number of patients in our study was 192, of whom 113 were men (58.9%) and 79 were women (41.1%). The mean age of the patients was 58.66 ± 15.43. All patients had hemoptysis on admission, and based on the doctor's assessment, the median amount of blood in the sputum was 100 (50–200) (Tables 1 and 2 ). Table 1 Demographic and clinical parameters Total patients 192 Gender: male / female 113 (58.9%) / 79 (41.1%) Age (years) 58.66 ± 15.43 Haemoptysis 100% Blood volume (ml) 100 (50–200) Hypertension arterialis 60 (31.3%) Bronchial asthma 18 (9.4%) Bronchiectasis 27 (14.1%) Chronic renal failure 2 (1.0%) Neoplasm 15 (7.8%) Family burden 4 (2.1%) Table 2 Clinical and biochemical parameters, anatomical findings and used coils Systolic pressure (mmHg) 128.78 ± 18.30 Diastolic pressure (mmHg) 78.17 ± 11.98 Oxygen saturation (%) 94.93 ± 4.18 White blood cells (x10 9 / L) 8.02 ± 2.84 Red blood cells (x10 12 / L) 4.40 ± 0.63 Hemoglobin (g / L) 125.44 ± 21.09 Hematocrit (L / L) 0.39 ± 0.05 Platelets (x10 9 / L) 259.20 ± 76.05 International Normalized Ratio 1.06 (1.00-1.16) Activated Partial Thromboplastin Time (s) 30.35 (27.21–35.10) Blood urea nitrogen (mmol / L) 6.50 (5.30–9.25) Creatinine (µmol / L) 78.00 (59.00-108.00) Number of interventions: 1 / 2 and more 167 (87.0%) / 25 (13.0%) Localization: right / left / bilateral 125 (65.1%) / 61 (31.8%) / 6 (3.1%) Arteriovenous malformations 53 (27.6%) Localization of arteriovenous malformations: right / left / bilateral 28 (14.6%) / 18 (9.4%) / 6 (3.1%) Bronchial arteries: 2mm 91 (47.4%) / 101 (52.6%) Sphere: 45 (23.4%) Coils: 147 (76.6%) Number of coils 2.00 (1.00–2.00) 1 52 (27.1%) 2 65 (33.9%) 3 25 (13.0%) 4 4 (2.1%) 5 1 (0.5%) Elevated systolic blood pressure had 60 patients (31.3%), 14.1% patients had previously verified bronchiectasis, 9.4% patients had bronchial asthma, 7.8% patients had verified lung malignancy and 1.0% patients had verified renal failure. A family history of AVM was registered at four patients (2.1%). The average systolic pressure was 128.78 ± 18.30 mmHg, diastolic 78.17 ± 11.98 mmHg, while the average oxygen saturation (SpO2) was 94.93 ± 4.18%. The average laboratory values were within the reference range. They were: White blood cells 8.02 ± 2.84 x10 9 / L, Red blood cells 4.40 ± 0.63 x10 12 / L, Hemoglobin 125.44 ± 21.09 g / L, Hematocrit 0.39 ± 0.05 L / L, Platelets 259.20 ± 76.05 x10 9 / L, International Normalized Ratio or INR 1.06 (1.00-1.16), Activated Partial Thromboplastin Time or aPTT 30.35 (27.21–35.10) s, Blood urea nitrogen 6.50 (5.30–9.25) mmol / L, and Creatinine 78.00 (59.00-108.00) µmol / L. Based on MDCT or selective angiography findings, it was determined that the cause of hemoptysis (in the form of pathological AV networks or tortuous and dilated BAs) in 125 patients (65.1%) was on the right, in 61 (31.8%) on the left, while in six patients (3.1%) cause of hemoptysis was bilateral. AV malformations, as pathological network of blood vessels was verified in 53 patients (27.6%), of which in 28 patients (14.6%) on the right, in 18 patients (9.4%) on the left, and in 6 (3.1%) bilateral. BAs dilatation (diameter above 2 mm) existed in 101 patients (52.6%), while 91 patients (47.4%) had a normal diameter < 2 mm. BAE was performed with coils in 147 patients (76.6%), while in 45 patients (23.4%) embolization beads were applied. Embolization beads were used only in patients in whom the slightest possibility of AV shunts was ruled out by angiographic examination. The average number of coils consumed per patient was two (1.00–5.00). Namely, we used one coil in 52 patients (27.1%), two coils in 65 patients (33.9%), while three coils were used in 25 patients (13.0%). In four patients (2.1%) four coils were used and five coils in one patient (0.5%). In 167 patients (87.0%) we performed single intervention, while 25 patients (13.0%) needed reintervention. Discussion BAs vascularize the airways, trachea, bronchi and associated branches, esophagus, visceral pleura, as well as vasa vasorum of the thoracic aorta and pulmonary arteries, as well as lymph nodes, pulmonary veins and nerve structures [ 2 , 12 ]. In addition to nutritional function, BAs capillaries form anastomoses with capillaries pulmonary artery (PA) network, whereby there is normal anatomical communication of these two bloodstreams, pulmonary and systemic. In this way BAs, in addition to being nutritious, can also play a functional role in cases of reduced blood flow to the pulmonary alveolar membranes by PA [ 13 ]. BAs are usually originated from the descending part of the thoracic aorta. In about 70% of cases, at the level of thoracic spine (Th) V and VI, i.e. immediately below the bifurcation of the trachea. The four most prevalent patterns of bronchial artery anatomy (Fig. 4 ) [ 14 ] - Type I (40.6%): single right bronchial artery via intercostobronchial trunk (ICBT), paired left bronchial arteries. Type II (21.3%): single right bronchial artery via ICBT, single left bronchial artery. Type III (20.6%): paired right bronchial arteries with one from ICBT, paired left bronchial arteries. Type IV (9.7%): paired right bronchial arteries with one from ICBT, solitary left bronchial artery. In about 10% of cases the origin is at another level. In about 20% of cases BAs are separated either from individual branches of the thoracic aorta (thyrocervical, brachiocephalic, subclavian, internal mammary, etc.) or have their ostium in the abdomen (directly from the aorta, inferior phrenic, TC, etc.) [ 15 , 16 ]. Right BA usually has a common initial stem with one of the intercostal arteries, the so-called ICBT. On the other hand, the left BA mostly starts directly from the aorta. Of the numerous anatomical variations and collaterals with systemic arteries, the Adamkiewicz artery (anterior spinal artery), should be singled out, which in 5% of cases may originate from ICBT immediately after the ostium [ 17 ]. Thus, in the case of embolization of ICBT and Adamkiewitz artery can cause anterior spinal artery syndrome, followed by loss of control of urination and defecation [ 18 ]. This is something that must be kept in mind when embolizing the right BA, and therefore a more supraselective approach is always used. Adekvatna dijagnostika i planiranje, pre same embolizacije, su se pokazali od značaja, za uspeh procedure i smanjenje učestalosti eventualnih komplikacija [ 19 ]. Indications for BAE are mass hemoptysis. Mild or moderate haemoptysis can be treated with conservative therapy (anti-inflammatory or anti-infective). Surgical therapy, therapy of choice, until the development of interventional vascular radiology, and embolization treatments, is today reserved for failed embolizations, or parenchymal pathological processes (with a high mortality rate of 4–19%) [ 20 ]. Massive hemoptysis is treated by selective embolization, as the method of choice. There are different definitions of massive hemoptysis. They are usually defined as bleeding 100-1000ml for 24-48h [ 21 ]. However, probably the most appropriate definition of bleeding is 200ml and more for 24h, bleeding which causes hemodynamic and respiratory failures or bleeding that lead to a decrease in hematocrit on 30% or lower [ 22 ]. As part of preembolization diagnostics, it is recommended to perform chest X-ray, bronchoscopy and chest MDCT. Chest X-ray findings may indicate bronchiectasis, shadows of soft tissue intensity (which differential diagnostically may correspond to AVM, consolidation, hemorrhagic lesions, etc.). Bronchoscopy can determine the branch of the airways in which there is fresh or coagulated hemorrhagic content and thus indirectly localize the area of ​​bleeding. Finally, with the MDCT findings, whether it is chest MDCT or MDCT of thoracic aorta (TA), we can show pathologically altered BAs, tortuous, dilated, with possibly a pathological network on the periphery. In addition, bronchiectasis can be found, hemorrhagic consolidation lesions in the alveoli, signs of specific processes, neoplasms, etc. Selective angiography of BAs most accurately shows BAs, their caliber, course, anastomoses with systemic arteries, as well as the existence of pathological AV communications (so-called shunts). As mentioned before, the normal diameter of BAs is up to 2 mm, thus the MDCT finding of BAs with a larger diameter of 2 mm is considered pathological, i.e. we say that BAs are dilated [ 23 ]. Our experience has shown that BAs are best visualized by MDCT examination, by setting the trigger on the descending part of TA, at the level of carina trachea, at the level of the expected most common ostium BAs. Section thickness is 1mm. In this way, it is not necessary to perform chest MDCT, in three phases, but only a modified form of MDCT of TA. In ratio 6:4 (respectively), we embolized BAs in men and women. The average age was 59 years. All patients had hemoptysis, which led the patients to us. The average amount of coughed up blood was 100 ml, but it should be emphasized, that this was a quantity that was verified by direct examination by a doctor, and that patients anamnestically stated larger amounts, on one or more occasions. For the sake of objectivity, we did not provide this information. Significantly more frequent bleeding originated from the BAs on the right side (65.1%), detected by bronchoscopy, MDCT and /or selective angiography findings of altered BAs and pathological vascular network consolidation lesions. BAs themselves were dilated in approximately one half of the patients (52.6%), i.e. their diameter was above 2 mm. In 27.6% of patients, on the basis of MDCT findings, or more often on the basis of selective angiography of BAs, the presence of AV malformation of BAs was determined, more often (14.6%) on the right. We used coil as an embolizing agent in approximately three quarters of the patients (76.6%), in avoid frequent existence of pathological AV communications, and the possibility of embolization of the systemic circulation. Such systemic embolization could carry complication up to 6.6% [ 10 ]. In one quarter of patients, in whom we were absolutely certain that there is no AV shunts, we used embolic beads. By this way, we did not record any complications, that could happen from the penetration of embolization particles into the systemic circulation. The average number of coils that needed to be used per patient was two. Embolization of BAs, mostly by coils, is efficient method, so in a significant majority of patients (87.0%), was performed only one intervention, while reintervention was necessary in 13.0%, comparing to up to 57.0%, in studies that using beads or liquid embolization agents, such as polyvinyl alcohol [ 10 ]. Conclusions BAE is an effective endovascular method for the care of patients with massive hemoptysis, comfortable for the patient, with minimal risk. It is necessary to exclude the possibility of embolization of Adamkiewitz artery with a more distal or, if possible, supraselective approach. Hemoptysis, as well as the need for embolization, occurs almost equally in men and women, while the right BA, is more often affected. In one-half, dilatation of BAs is verified, while in one quarter of patients the presence of AVM can be observed. On average, embolization is successfully performed with two inches per patient. Using coils as an embolization agent is a more effective and safer method, compared to embolization particles or liquid agents. Declarations Acknowledgments We thank a lot all colleagues from the Institute of Radiology Military Medical Academy who helped during the realization of this study. Conflict of interest The authors declare that they have no conflict of interest. Funding NA. Author contibution I.S., N.R. and M.M. wrote the main manuscript. I.S. D.K. and N.R. conducted the statistical analysis . I.S., U.M. and N.R. prepared Table 1. M.M., J.B.S. and D.K. prepared Table 2. I.S., U.M., A.J. and J.B.S. prepared Fig. 1-3. N.R., M.M. and D.K. prepared Fig. 4. All authors reviewed the manuscript. Ethics, Consent to Participate, and Consent to Publish declarations This research protocol was approved by the Ethics Committee of MMA (Approval No 42/2025 on 04/09/2025) according to the principles of the Declaration of Helsinki. All of the participants signed an informed consent to participate in the study. References Bruzzi JF, Rémy-Jardin M, Delhaye D, Teisseire A, Khalil C, Rémy J. Multi-detector row CT of hemoptysis. Radiographics. 2006;26(1):3-22. Yoon W, Kim JK, Kim YH, Chung TW, Kang HK. Bronchial and nonbronchial systemic artery embolization for life-threatening hemoptysis: a comprehensive review. Radiographics. 2002;22(6):1395-409. Cauldwell EW, Siekert RG, Lininger RE, Anson BJ. The bronchial arteries; an anatomic study of 150 human cadavers. Surg Gynecol Obstet. 1948;86(4):395-412. Khalil A, Attia S, Tibaoui A, Souli A, Khoury R, Mohammad W. Hemoptysis: From Diagnosis to Treatment. J Belg Soc Radiol. 2023 Nov 21;107(1):89. 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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-6574276","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":462930246,"identity":"3cb1b024-97e8-4098-b9ce-1b355e757814","order_by":0,"name":"Igor 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21:23:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6574276/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6574276/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83677268,"identity":"6c366a4f-b67a-4ba3-834e-80cd764c17ab","added_by":"auto","created_at":"2025-05-30 15:05:11","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":606240,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ea and b\u003c/strong\u003e MDCT of thorax, coronary section: tortuous and dilated right BA (arrows)\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6574276/v1/c9b56fa1b4dbba090352f4ae.png"},{"id":83676536,"identity":"0bd8b41d-ab38-443d-8c9c-6427bcfa33c2","added_by":"auto","created_at":"2025-05-30 14:57:11","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":801035,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ea and b\u003c/strong\u003e Selective and supraselective angiography of the right BA: dilated and tortuous BA (arrows)\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6574276/v1/44f8996d1248361dfccacada.png"},{"id":83676534,"identity":"a0a623bf-72bb-4d7c-9241-fc59f732e432","added_by":"auto","created_at":"2025-05-30 14:57:11","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":467450,"visible":true,"origin":"","legend":"\u003cp\u003ePostembolization selective angiography of the right BA: excluded BA from circulation after coil (white arrow), with preserved Adamkiewicz (anterior spinal) artery (black arrow)\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6574276/v1/c01de5279d78b15df10a8eb1.png"},{"id":83676537,"identity":"f873cfed-4047-467f-946e-ec5d3dd5d77d","added_by":"auto","created_at":"2025-05-30 14:57:11","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":247885,"visible":true,"origin":"","legend":"\u003cp\u003eAnatomical variations of bronchial arteries (Type I-IV)\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-6574276/v1/fe7e937c5530e049bd7cc459.png"},{"id":83677269,"identity":"1d0f575e-992e-48e7-a5e4-a9889c7b25f8","added_by":"auto","created_at":"2025-05-30 15:05:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3510592,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6574276/v1/f754a4d0-5f9b-4cc9-9b5f-b4febc48bf2f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Embolization of bronchial arteries: Single center experiences","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBronchial arteries (BAs) are nutritional blood vessels of structures in the chest, of small caliber up to 2 mm on the ostium and, under normal physiological conditions, do not participate in gas exchange [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. There are usually two BAs for the left lung and one for the right. In a study of 150 cadavers Cauldwell et al. studied the anatomical variations of the origin of BAs, in the case when they started directly from thoracic aorta [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] and based on that they defined four anatomical variants of BAs (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIndications for BAs embolization (BAE) are massive hemoptysis, as bleeding from BAs is the cause of massive hemoptysis in about 90% of cases [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In 5% of cases bleeding originates from the pulmonary arteries, and in the remaining 5% either from the aorta (tracheobronchial fistula, ruptured aneurysm) or from other systemic arteries [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNon-treatment of massive and recurrent hemoptysis is associated with a mortality rate between 9% and 38% [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Causes of massive hemoptysis are most common: bronchiectasis, neoplasms, arteriovenous malformations (AVM), aspergillosis, tuberculosis, etc [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Chest X-ray, bronchoscopy and chest multidetector computed tomography (MDCT) are recommended diagnostic procedures before intervention [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBlood vessel embolization is an endovascular method of interventional vascular radiology, which in a safe and patient-friendly way enables therapeutic occlusion of blood vessels and thus stopping of bleeding.\u003c/p\u003e \u003cp\u003eThe aim of our study was to present the basic characteristics of patients who underwent bronchial artery embolization and to point out the great importance of this therapeutic method.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eIt is a single-center retrospective cross-sectional study, which included all patients who underwent embolization, in the period from June 2007 to October 2023 due to hemoptysis and usually after verification of altered bronchial arteries.\u003c/p\u003e \u003cp\u003eAfter bronchoscopy and/or MDCT aortography, (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003ea and \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eb) patients were referred to BAE to the Angio Room (\u003cem\u003eSiemens\u0026reg; Artis Zee\u003c/em\u003e, Germany), at the Department of Interventional Vascular Radiology, Institute of Radiology, Military Medical Academy (MMA), Belgrade. Selective BAs angiography was performed, mainly by right transfemoral approach and Seldinger's method (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003ea). Of the diagnostic catheters, the most commonly used were H1H, then the left coronary catheter, SIM I or SIM II (depending on the diameter of the aorta), Cobra, etc (\u003cem\u003eTERUMO Interventional Systems\u003c/em\u003e, USA). If we were not able to find BAs in the places of the most common expected ostium, we resorted to aortography, Pigtail catheter. Then with a microchateter \u003cem\u003ePrograte\u0026trade;\u003c/em\u003e (\u003cem\u003eTERUMO Interventional Systems\u003c/em\u003e, USA) we entered deeper into the artery, either to possibly avoid the Adamkiewitz artery (if it is a right BA), or to supraselectively enter the artery, which needed to be embolized (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eb). After supraselective angiography, embolization was performed. BAE can be performed with embolizing beads or coils [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. We opted mainly for embolization coils (\u003cem\u003eAzur hydrocoil\u003c/em\u003e\u0026trade;, \u003cem\u003eTERUMO Interventional Systems\u003c/em\u003e, USA), due to the frequent existence of pathological AV communications, and the possibility of embolization of the systemic circulation. After embolization, we checked the exclusion of pathologically altered blood vessels from the circulation on control selective / supraselective angiography (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eDescriptive statistical analysis was performed, so all values ​​were presented either in the form of an average value with standard deviation if it was a normal data distribution or in the form of a median with an interquartile range (25-75th percentile) if it was not normally distributed data. Distribution was verified by the Kolmogorov-Smirnov test. Attribute variables were presented in the form of frequencies of individual categories. Statistical analysis was performed in the statistical program IBM SPSS version 26.0.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe total number of patients in our study was 192, of whom 113 were men (58.9%) and 79 were women (41.1%). The mean age of the patients was 58.66\u0026thinsp;\u0026plusmn;\u0026thinsp;15.43. All patients had hemoptysis on admission, and based on the doctor's assessment, the median amount of blood in the sputum was 100 (50\u0026ndash;200) (Tables\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic and clinical parameters\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal patients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e192\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender: male / female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e113 (58.9%) / 79 (41.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58.66\u0026thinsp;\u0026plusmn;\u0026thinsp;15.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHaemoptysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood volume (ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100 (50\u0026ndash;200)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension arterialis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60 (31.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBronchial asthma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (9.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBronchiectasis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (14.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic renal failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeoplasm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (7.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily burden\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (2.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical and biochemical parameters, anatomical findings and used coils\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSystolic pressure (mmHg)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e128.78\u0026thinsp;\u0026plusmn;\u0026thinsp;18.30\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiastolic pressure (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78.17\u0026thinsp;\u0026plusmn;\u0026thinsp;11.98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOxygen saturation (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e94.93\u0026thinsp;\u0026plusmn;\u0026thinsp;4.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite blood cells (x10\u003csup\u003e9\u003c/sup\u003e / L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.02\u0026thinsp;\u0026plusmn;\u0026thinsp;2.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRed blood cells (x10\u003csup\u003e12\u003c/sup\u003e / L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoglobin (g / L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e125.44\u0026thinsp;\u0026plusmn;\u0026thinsp;21.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHematocrit (L / L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.39\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlatelets (x10\u003csup\u003e9\u003c/sup\u003e / L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e259.20\u0026thinsp;\u0026plusmn;\u0026thinsp;76.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInternational Normalized Ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.06 (1.00-1.16)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eActivated Partial Thromboplastin Time (s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30.35 (27.21\u0026ndash;35.10)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood urea nitrogen (mmol / L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.50 (5.30\u0026ndash;9.25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCreatinine (\u0026micro;mol / L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78.00 (59.00-108.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of interventions: 1 / 2 and more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e167 (87.0%) / 25 (13.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLocalization: right / left / bilateral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e125 (65.1%) / 61 (31.8%) / 6 (3.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArteriovenous malformations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53 (27.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLocalization of arteriovenous malformations: right / left / bilateral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (14.6%) / 18 (9.4%) / 6 (3.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBronchial arteries: \u0026lt;2mm / \u0026gt;2mm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91 (47.4%) / 101 (52.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSphere:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45 (23.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoils:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e147 (76.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of coils\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.00 (1.00\u0026ndash;2.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52 (27.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65 (33.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (13.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (2.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eElevated systolic blood pressure had 60 patients (31.3%), 14.1% patients had previously verified bronchiectasis, 9.4% patients had bronchial asthma, 7.8% patients had verified lung malignancy and 1.0% patients had verified renal failure. A family history of AVM was registered at four patients (2.1%).\u003c/p\u003e \u003cp\u003eThe average systolic pressure was 128.78\u0026thinsp;\u0026plusmn;\u0026thinsp;18.30 mmHg, diastolic 78.17\u0026thinsp;\u0026plusmn;\u0026thinsp;11.98 mmHg, while the average oxygen saturation (SpO2) was 94.93\u0026thinsp;\u0026plusmn;\u0026thinsp;4.18%. The average laboratory values were within the reference range. They were: White blood cells 8.02\u0026thinsp;\u0026plusmn;\u0026thinsp;2.84 x10\u003csup\u003e9\u003c/sup\u003e / L, Red blood cells 4.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63 x10\u003csup\u003e12\u003c/sup\u003e / L, Hemoglobin 125.44\u0026thinsp;\u0026plusmn;\u0026thinsp;21.09 g / L, Hematocrit 0.39\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05 L / L, Platelets 259.20\u0026thinsp;\u0026plusmn;\u0026thinsp;76.05 x10\u003csup\u003e9\u003c/sup\u003e / L, International Normalized Ratio or INR 1.06 (1.00-1.16), Activated Partial Thromboplastin Time or aPTT 30.35 (27.21\u0026ndash;35.10) s, Blood urea nitrogen 6.50 (5.30\u0026ndash;9.25) mmol / L, and Creatinine 78.00 (59.00-108.00) \u0026micro;mol / L.\u003c/p\u003e \u003cp\u003eBased on MDCT or selective angiography findings, it was determined that the cause of hemoptysis (in the form of pathological AV networks or tortuous and dilated BAs) in 125 patients (65.1%) was on the right, in 61 (31.8%) on the left, while in six patients (3.1%) cause of hemoptysis was bilateral. AV malformations, as pathological network of blood vessels was verified in 53 patients (27.6%), of which in 28 patients (14.6%) on the right, in 18 patients (9.4%) on the left, and in 6 (3.1%) bilateral. BAs dilatation (diameter above 2 mm) existed in 101 patients (52.6%), while 91 patients (47.4%) had a normal diameter\u0026thinsp;\u0026lt;\u0026thinsp;2 mm.\u003c/p\u003e \u003cp\u003eBAE was performed with coils in 147 patients (76.6%), while in 45 patients (23.4%) embolization beads were applied. Embolization beads were used only in patients in whom the slightest possibility of AV shunts was ruled out by angiographic examination. The average number of coils consumed per patient was two (1.00\u0026ndash;5.00). Namely, we used one coil in 52 patients (27.1%), two coils in 65 patients (33.9%), while three coils were used in 25 patients (13.0%). In four patients (2.1%) four coils were used and five coils in one patient (0.5%).\u003c/p\u003e \u003cp\u003eIn 167 patients (87.0%) we performed single intervention, while 25 patients (13.0%) needed reintervention.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eBAs vascularize the airways, trachea, bronchi and associated branches, esophagus, visceral pleura, as well as vasa vasorum of the thoracic aorta and pulmonary arteries, as well as lymph nodes, pulmonary veins and nerve structures [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In addition to nutritional function, BAs capillaries form anastomoses with capillaries pulmonary artery (PA) network, whereby there is normal anatomical communication of these two bloodstreams, pulmonary and systemic. In this way BAs, in addition to being nutritious, can also play a functional role in cases of reduced blood flow to the pulmonary alveolar membranes by PA [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBAs are usually originated from the descending part of the thoracic aorta. In about 70% of cases, at the level of thoracic spine (Th) V and VI, i.e. immediately below the bifurcation of the trachea. The four most prevalent patterns of bronchial artery anatomy (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e) [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] - Type I (40.6%): single right bronchial artery via intercostobronchial trunk (ICBT), paired left bronchial arteries. Type II (21.3%): single right bronchial artery via ICBT, single left bronchial artery. Type III (20.6%): paired right bronchial arteries with one from ICBT, paired left bronchial arteries. Type IV (9.7%): paired right bronchial arteries with one from ICBT, solitary left bronchial artery.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn about 10% of cases the origin is at another level. In about 20% of cases BAs are separated either from individual branches of the thoracic aorta (thyrocervical, brachiocephalic, subclavian, internal mammary, etc.) or have their ostium in the abdomen (directly from the aorta, inferior phrenic, TC, etc.) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Right BA usually has a common initial stem with one of the intercostal arteries, the so-called ICBT. On the other hand, the left BA mostly starts directly from the aorta.\u003c/p\u003e \u003cp\u003eOf the numerous anatomical variations and collaterals with systemic arteries, the Adamkiewicz artery (anterior spinal artery), should be singled out, which in 5% of cases may originate from ICBT immediately after the ostium [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Thus, in the case of embolization of ICBT and Adamkiewitz artery can cause anterior spinal artery syndrome, followed by loss of control of urination and defecation [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. This is something that must be kept in mind when embolizing the right BA, and therefore a more supraselective approach is always used. Adekvatna dijagnostika i planiranje, pre same embolizacije, su se pokazali od značaja, za uspeh procedure i smanjenje učestalosti eventualnih komplikacija [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIndications for BAE are mass hemoptysis. Mild or moderate haemoptysis can be treated with conservative therapy (anti-inflammatory or anti-infective). Surgical therapy, therapy of choice, until the development of interventional vascular radiology, and embolization treatments, is today reserved for failed embolizations, or parenchymal pathological processes (with a high mortality rate of 4\u0026ndash;19%) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMassive hemoptysis is treated by selective embolization, as the method of choice. There are different definitions of massive hemoptysis. They are usually defined as bleeding 100-1000ml for 24-48h [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. However, probably the most appropriate definition of bleeding is 200ml and more for 24h, bleeding which causes hemodynamic and respiratory failures or bleeding that lead to a decrease in hematocrit on 30% or lower [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAs part of preembolization diagnostics, it is recommended to perform chest X-ray, bronchoscopy and chest MDCT. Chest X-ray findings may indicate bronchiectasis, shadows of soft tissue intensity (which differential diagnostically may correspond to AVM, consolidation, hemorrhagic lesions, etc.). Bronchoscopy can determine the branch of the airways in which there is fresh or coagulated hemorrhagic content and thus indirectly localize the area of ​​bleeding. Finally, with the MDCT findings, whether it is chest MDCT or MDCT of thoracic aorta (TA), we can show pathologically altered BAs, tortuous, dilated, with possibly a pathological network on the periphery. In addition, bronchiectasis can be found, hemorrhagic consolidation lesions in the alveoli, signs of specific processes, neoplasms, etc. Selective angiography of BAs most accurately shows BAs, their caliber, course, anastomoses with systemic arteries, as well as the existence of pathological AV communications (so-called shunts).\u003c/p\u003e \u003cp\u003eAs mentioned before, the normal diameter of BAs is up to 2 mm, thus the MDCT finding of BAs with a larger diameter of 2 mm is considered pathological, i.e. we say that BAs are dilated [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Our experience has shown that BAs are best visualized by MDCT examination, by setting the trigger on the descending part of TA, at the level of carina trachea, at the level of the expected most common ostium BAs. Section thickness is 1mm. In this way, it is not necessary to perform chest MDCT, in three phases, but only a modified form of MDCT of TA.\u003c/p\u003e \u003cp\u003eIn ratio 6:4 (respectively), we embolized BAs in men and women. The average age was 59 years. All patients had hemoptysis, which led the patients to us. The average amount of coughed up blood was 100 ml, but it should be emphasized, that this was a quantity that was verified by direct examination by a doctor, and that patients anamnestically stated larger amounts, on one or more occasions. For the sake of objectivity, we did not provide this information. Significantly more frequent bleeding originated from the BAs on the right side (65.1%), detected by bronchoscopy, MDCT and /or selective angiography findings of altered BAs and pathological vascular network consolidation lesions.\u003c/p\u003e \u003cp\u003eBAs themselves were dilated in approximately one half of the patients (52.6%), i.e. their diameter was above 2 mm. In 27.6% of patients, on the basis of MDCT findings, or more often on the basis of selective angiography of BAs, the presence of AV malformation of BAs was determined, more often (14.6%) on the right.\u003c/p\u003e \u003cp\u003eWe used coil as an embolizing agent in approximately three quarters of the patients (76.6%), in avoid frequent existence of pathological AV communications, and the possibility of embolization of the systemic circulation. Such systemic embolization could carry complication up to 6.6% [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In one quarter of patients, in whom we were absolutely certain that there is no AV shunts, we used embolic beads. By this way, we did not record any complications, that could happen from the penetration of embolization particles into the systemic circulation. The average number of coils that needed to be used per patient was two.\u003c/p\u003e \u003cp\u003eEmbolization of BAs, mostly by coils, is efficient method, so in a significant majority of patients (87.0%), was performed only one intervention, while reintervention was necessary in 13.0%, comparing to up to 57.0%, in studies that using beads or liquid embolization agents, such as polyvinyl alcohol [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eBAE is an effective endovascular method for the care of patients with massive hemoptysis, comfortable for the patient, with minimal risk. It is necessary to exclude the possibility of embolization of Adamkiewitz artery with a more distal or, if possible, supraselective approach. Hemoptysis, as well as the need for embolization, occurs almost equally in men and women, while the right BA, is more often affected. In one-half, dilatation of BAs is verified, while in one quarter of patients the presence of AVM can be observed. On average, embolization is successfully performed with two inches per patient. Using coils as an embolization agent is a more effective and safer method, compared to embolization particles or liquid agents.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank a lot all colleagues from the Institute of Radiology Military Medical Academy who helped during the realization of this study.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNA.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAuthor contibution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI.S., N.R. and M.M. wrote the main manuscript. I.S. D.K. and N.R. conducted the statistical analysis . I.S., U.M. and N.R. prepared Table 1. M.M., J.B.S. and D.K. prepared Table 2. I.S., U.M., A.J. and J.B.S. prepared Fig. 1-3. N.R., M.M. and D.K. prepared Fig. 4. All authors reviewed the manuscript.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eEthics, Consent to Participate, and Consent to Publish declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research protocol was approved by the Ethics Committee of MMA (Approval No 42/2025 on 04/09/2025) according to the principles of the Declaration of Helsinki. All of the participants signed an informed consent to participate in the study.\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003e\u003cem\u003eBruzzi JF, R\u0026eacute;my-Jardin M, Delhaye D, Teisseire A, Khalil C, R\u0026eacute;my J.\u003c/em\u003e Multi-detector row CT of hemoptysis. 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Br J Anaesth. 2002;88(2):291-5. \u003c/li\u003e\n\u003cli\u003e\u003cem\u003ePearse EO, Bryan AJ.\u003c/em\u003e Massive haemoptysis 27 years after surgery for coarctation of the aorta. J R Soc Med. 2001;94(12):640-1. \u003c/li\u003e\n\u003cli\u003e\u003cem\u003eKathuria H, Hollingsworth HM, Vilvendhan R, Reardon C. \u003c/em\u003eManagement of life-threatening hemoptysis. J Intensive Care. 2020 Apr 5;8:23. \u003c/li\u003e\n\u003cli\u003e\u003cem\u003eYazıcıoğlu A, Yekeler E, Yazıcı \u0026Uuml;, Aydın E, Taştepe İ, Karaoğlanoğlu N.\u003c/em\u003e Management of Massive Hemoptysis: Analyses of 58 Patients. Turk Thorac J. 2016;17(4):148-52. Erratum in: Turk Thorac J. 2018;19(2):100. \u003c/li\u003e\n\u003cli\u003e\u003cem\u003ePrey B, Francis A, Williams J, Krishnadasan B. \u003c/em\u003eEvaluation and Treatment of Massive Hemoptysis. Surg Clin North Am. 2022 Jun;102(3):465-81. \u003c/li\u003e\n\u003cli\u003e\u003cem\u003eSidhu M, Wieseler K, Burdick TR, Shaw DW.\u003c/em\u003e Bronchial artery embolization for hemoptysis. Semin Intervent Radiol. 2008;25(3):310-8. \u003c/li\u003e\n\u003cli\u003e\u003cem\u003ePanda A, Bhalla AS, Goyal A. \u003c/em\u003eBronchial artery embolization in hemoptysis: a systematic review. Diagn Interv Radiol. 2017 Jul-Aug;23(4):307-17. \u003c/li\u003e\n\u003cli\u003e\u003cem\u003ePump KK.\u003c/em\u003e Distribution of bronchial arteries in the human lung. Chest. 1972;62(4):447-51. \u003c/li\u003e\n\u003cli\u003e\u003cem\u003eMiyazawa K, Katori R, Ishikawa K, Yamaki M, Kobayashi Y.\u003c/em\u003e Selective bronchial arteriography and bronchial blood flow; correlative study. Chest. 1970;57(5):416-22.\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eSopko DR, Smith TP.\u003c/em\u003e Bronchial artery embolization for hemoptysis. Semin Intervent Radiol. 2011;28(1):48-62. \u003c/li\u003e\n\u003cli\u003e\u003cem\u003eStoll JF, Bettmann MA.\u003c/em\u003e Bronchial artery embolization to control hemoptysis: a review. Cardiovasc Intervent Radiol. 1988;11(5):263-9. \u003c/li\u003e\n\u003cli\u003e\u003cem\u003eBotenga ASJ.\u003c/em\u003e Selective Bronchial and Intercostal Arteriography. Baltimore: Williams and Wilkins. 1970. p.7-82.\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eSwanson KL, Johnson CM, Prakash UB, McKusick MA, Andrews JC, Stanson AW.\u003c/em\u003e Bronchial artery embolization: experience with 54 patients. Chest. 2002;121(3):789-95. \u003c/li\u003e\n\u003cli\u003e\u003cem\u003eWan IY, Angelini GD, Bryan AJ, Ryder I, Underwood MJ.\u003c/em\u003e Prevention of spinal cord ischaemia during descending thoracic and thoracoabdominal aortic surgery. Eur J Cardiothorac Surg. 2001;19(2):203-13. \u003c/li\u003e\n\u003cli\u003e\u003cem\u003eJavorka V, Malik M, Mizickova M, et al.\u003c/em\u003e Intraprocedural complications of uterine fibroid embolisation and their impact on long-term clinical outcome. Bratisl Lek Listy. 2019;120(10):734-8. \u003c/li\u003e\n\u003cli\u003e\u003cem\u003eIttrich H, Bockhorn M, Klose H, Simon M. \u003c/em\u003eThe Diagnosis and Treatment of Hemoptysis. Dtsch Arztebl Int. 2017;114(21):371-81. \u003c/li\u003e\n\u003cli\u003e\u003cem\u003eCharya AV, Holden VK, Pickering EM. \u003c/em\u003eManagement of life-threatening hemoptysis in the ICU. J Thorac Dis. 2021 Aug;13(8):5139-58.\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eEndo S, Otani S, Saito N, Hasegawa T, Kanai Y, Sato Y, et al.\u003c/em\u003e Management of massive hemoptysis in a thoracic surgical unit. Eur J Cardiothorac Surg. 2003;23(4):467-72.\u003c/li\u003e\n\u003cli\u003e\u003cem\u003ePoyyamoli S, Swamiappan E, Gandhi J, Ranasingh RK, Cherian MP, Mehta P. \u003c/em\u003eNon-aortic vascular findings on chest CT angiogram: including arch vessels and bronchial arteries. Cardiovasc Diagn Ther. 2019 Aug;9 (Suppl 1):S59-S73. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bratislava-medical-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Bratislava Medical Journal](https://link.springer.com/journal/44411)","snPcode":"44411","submissionUrl":"https://submission.springernature.com/new-submission/44411/3","title":"Bratislava Medical Journal","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"bronchial arteries, embolization, massive hemoptysis, interventional vascular radiology, multidetector computed tomography, supraselective angiography","lastPublishedDoi":"10.21203/rs.3.rs-6574276/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6574276/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground/Aim\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe most common indications for bronchial-artery embolisation are massive hemoptysis. The aim of our study was to present the basic characteristics of patients who underwent bronchial-artery embolisation and to point out the great importance of this therapeutic method.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIt is a single-center retrospective cross-sectional study, which included all patients who underwent embolization in the period from June 2007 to October 2023 due to hemoptysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe total number of patients in our study was 192, with average amount of coughed up blood that was 100 ml. In ratio 6:4 (respectively), we performed bronchial-artery embolisation in men and women. The average age was 59 years. Based on bronchoscopy, multidetector computed tomography findings or selective angiography, it was determined that the cause of hemoptysis in 65.1% patients was on the right, in 31.8% on the left, and in 3.1% the cause of hemoptysis was bilateral. Bronchial arteries dilatation (diameter above 2 mm) existed in 52.6% patients. Pathological network of blood vessels was verified in 27.6% patients. In approximately three quarters of the patients (76.6%), we used coils as an embolizing agent, to avoid the possibility of embolization of the systemic circulation due to frequent existence of pathological arteriovenous communication, so we had no complications. Embolizing beads were used in 23.4% of patients. The average number of coils consumed per patient was two. In 87.0% patients we performed single intervention, while 13.0% needed reintervention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe bronchial-artery embolisation is an effective endovascular method for the care of patients with massive hemoptysis, comfortable for the patient, with minimal risk. Using coils as an embolization agent is a more effective and safer method, compared to embolization particles or liquid agents.\u003c/p\u003e","manuscriptTitle":"Embolization of bronchial arteries: Single center experiences","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-30 14:57:07","doi":"10.21203/rs.3.rs-6574276/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-10T09:38:56+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-10T04:50:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-14T09:30:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"60760043281094518681737086192403871244","date":"2025-06-03T13:42:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"321999871873397334452811720830730562339","date":"2025-06-02T15:49:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"201462212876265609416470435188016768654","date":"2025-05-28T07:46:18+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-28T07:29:01+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-06T12:14:16+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-06T12:12:14+00:00","index":"","fulltext":""},{"type":"submitted","content":"Bratislava Medical Journal","date":"2025-05-01T21:21:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bratislava-medical-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Bratislava Medical Journal](https://link.springer.com/journal/44411)","snPcode":"44411","submissionUrl":"https://submission.springernature.com/new-submission/44411/3","title":"Bratislava Medical Journal","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"3321d586-c140-4116-b3ec-3592b741eb0b","owner":[],"postedDate":"May 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-08-13T09:39:16+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-30 14:57:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6574276","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6574276","identity":"rs-6574276","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}