Embolization of bronchial arteries of anomalous origin

Purpose: To highlight the importance of detecting bronchial arteries of anomalous origin in patients with massive or recurrent hemoptysis. Methods: In a series of 300 patients submitted to bronchial embolization in our hospital since 1986, we found 25 (8.3%) with 27 anomalous bronchial arteries. Eighteen patients presented with recurrent hemoptysis (10 massive) and seven with their first episode of massive hemoptysis. Results: Of the 27 anomalous bronchial arteries demonstrated, 24 originated from the aortic arch, one from the left thyrocervical trunk, one from the right subclavian artery, and one from the lower descending thoracic aorta; two of the arteries demonstrated showed no pathological findings. Hemoptysis resolved following the first embolization in 14 patients (56%). In nine patients (36%) more than one procedure was necessary to arrest hemorrhage. In two patients surgical intervention was required. One patient died from bleeding. Conclusions: In cases of hemorrhage when the cause is not easily identified, or in cases of recurrence in spite of accurate embolization of pathological arteries, the presence of bronchial arteries of anomalous origin should be considered. Embolization is more difficult in these cases and there is an increased risk of complications.