Bronchial artery embolization

What is hemoptysis (vomiting blood from the lungs)?

Hemoptysis is roughly spitting up blood, and its source is the lungs. It can be confused with gastrointestinal bleeding, which is a similar picture, by patients. Blood vomiting triggered by coughing, blood foamy and mixed with sputum, light red in color, alkaline content and lack of food particles are associated with hemoptysis, that is, vomiting blood originating from the lungs. Intense vomiting of blood originating from the lungs (massive hemoptysis) is seen in 5% of such bleedings. It is defined as spitting up more than 100 ml (about a tea glass) of blood in 24 hours and is a life-threatening condition. Therefore, it is a condition that needs to be treated.

Hemoptysis refers to the coughing up of blood or blood-tinged sputum from the respiratory tract, including the lungs. The most common causes of lung hemoptysis include:

Infections: Acute and chronic infections of the lungs, such as pneumonia, tuberculosis, and bronchitis, can cause hemoptysis.

Bronchiectasis: This is a condition in which the airways of the lungs become damaged, widened, and scarred, leading to coughing up of blood.

Lung cancer: Hemoptysis can be a symptom of lung cancer, especially in the later stages of the disease.

Pulmonary embolism: This occurs when a blood clot from elsewhere in the body travels to the lungs and blocks a blood vessel, leading to hemoptysis.

Pulmonary hypertension: This is a type of high blood pressure that affects the arteries in the lungs and can cause bleeding from the lungs.

Autoimmune disorders: Certain autoimmune disorders, such as Wegener's granulomatosis and Goodpasture's syndrome, can cause hemoptysis.

Trauma: Injuries to the chest or lungs, such as from a fall or a car accident, can cause hemoptysis.

It is important to seek medical attention if you experience hemoptysis, as it can be a sign of a serious underlying condition.

What are the causes of hemoptysis?

It is a condition that occurs when blood is spilled into the respiratory tract due to reasons such as injury, injury, retention, growth and new vessel development in the vessels adjacent to the respiratory system tubules that carry air to the lungs. There are two main arterial systems, namely the bronchial artery and the pulmonary artery, which provide the blood supply to the lungs. Ninety percent of massive hemoptysis cases originate from the bronchial artery, 5% from the pulmonary artery, and the remaining 5% from the nonbronchial systemic artery. It may originate from these and their branches. Enlargement of the bronchial tracts (airway tubes), tuberculosis (tuberculosis), aspergillous, pneumonia (pneumonia), Behçet's disease, trauma, escape of foreign bodies such as pin metal, lung cancers, lung abscess, collections of the lung, heart failure, some blood coagulation disorders, Some diseases such as coagulation in the main pulmonary vessels, vascular tangles can cause hemoptysis.

How is it diagnosed?

Diagnosis is made by the doctors of the relevant department with chest radiographs, bronchoscopy, computed tomography and classical dsa angiography examinations.

What treatment options are there?

There are treatment options such as bronchoscopic treatments, surgical interventions and interventional radiological vascular occlusion methods. In the bronchoscopic (treatment with thin tubes inserted into the airways) approach, if the bleeding focus can be detected, the bleeding is stopped, but it is not always easy to find the bleeding focus and control the bleeding in this focus. In surgical interventions, the vessels causing bleeding can be ligated and the relevant areas can be surgically removed. In cases requiring emergency intervention, the risk of death due to the surgical treatment method is slightly higher, but sometimes it is the method that should be preferred inevitably. Bronchial artery embolization or pulmonary artery embolization is the process of occlusion of the bleeding vessel by entering the vessel without surgery.

What is bronchial artery embolization:

Bronchial artery embolization (BAE) is a minimally invasive procedure used to treat various medical conditions that affect the bronchial arteries. These arteries supply blood to the lungs, and when they become diseased or damaged, they can cause a range of respiratory problems. BAE involves the injection of tiny particles or coils into the bronchial arteries to block the blood flow and reduce the symptoms of the underlying condition.

Before discussing BAE, it's important to understand what bronchial arteries are and what role they play in the respiratory system. Bronchial arteries are a network of blood vessels that arise from the thoracic aorta, the main artery that carries oxygen-rich blood from the heart to the rest of the body. The bronchial arteries supply blood to the lungs, specifically to the bronchi, the large air passages that branch off from the trachea (windpipe) and lead to the smaller airways in the lungs. The bronchial arteries provide oxygenated blood to the lung tissue, the bronchial tree, and the pleura, the thin membrane that lines the chest cavity and covers the lungs. They also play a role in regulating lung function, including airway resistance, gas exchange, and immune response.

Bronchial artery embolization is a minimally invasive procedure that involves the insertion of a catheter, a thin flexible tube, into an artery in the groin or wrist. The catheter is guided through the blood vessels until it reaches the bronchial arteries. Once the catheter is in position, the interventional radiologist injects tiny particles or coils into the bronchial arteries to block the blood flow. The particles or coils used in BAE are made of biocompatible materials that are designed to stay in place and gradually dissolve over time. By blocking the blood flow to the affected areas of the lungs, BAE reduces the symptoms of the underlying condition, including coughing, shortness of breath, and chest pain.

Massive hemoptysis is a medical emergency that occurs when a person coughs up large amounts of blood from the lungs. Massive hemoptysis can be caused by various conditions, including bronchiectasis, tuberculosis, lung cancer, and pulmonary embolism. BAE is an effective treatment option for massive hemoptysis, as it can quickly stop the bleeding and prevent further complications.

BAE may also be used to treat other lung conditions, such as bronchial artery aneurysms, arteriovenous malformations, and pulmonary fibrosis, but these are less common.

Bronchial artery embolization is a minimally invasive procedure used to treat various medical conditions that affect the bronchial arteries. BAE involves the injection of tiny particles or coils into the bronchial arteries to block the blood flow and reduce the symptoms of the underlying condition. BAE is an effective and safe treatment option for PAH and massive hemoptysis, with few side effects and minimal recovery time. Patients should discuss the benefits and risks of BAE with their healthcare provider to determine if this procedure is appropriate for their condition.

How is it done?

The patient is taken to the table by the interventional radiologists, and by entering through the main artery (bronchial embolization) or vein (pulmonary artery embolization) in the right groin, it is advanced upwards with the help of 2-3 mm thick thin pipes and very thin wires under the guidance of X-ray device (fluoroscopy, angiography device). Angiography images are taken by entering the bronchial arteries, pulmonary veins and other related vessels that make up this bleeding in the chest cavity. Veins causing bleeding and bleeding are detected. The vessels that cause bleeding are closed with thin wire coils, microspheres, sclerosing substances and plugs. You will not feel pain during and after the procedure. After the procedure, you will be sent back to your service.

What are the advantages?

It is a non-surgical treatment method. It is a painless and comfortable treatment that does not leave any traces on the skin, lasts approximately 30-60 minutes, and you can return to your daily life immediately after the treatment. Complication rates are very low. It can be easily reapplied in case of recurrence. This treatment method does not constitute an obstacle to other treatment methods, including subsequent surgery. The cure rate of the disease is quite high with this treatment method. Compared to being treated with surgery, it is quite comfortable and easy. Compared to surgery, the risks and complications are much less. It is faster for patients to return to their homes and daily life tempos. There is no need for narcosis, the procedure is completed with local anesthesia. Cosmetically, the results are quite satisfactory. There are no stitches or scars. The start and end of the treatment is very fast. The process ends quickly.  To summarize:

Non-surgical: BAE is a minimally invasive procedure that does not require surgery or general anesthesia.

Effective: BAE has a high success rate in reducing the symptoms of PAH and stopping massive hemoptysis.

Fast recovery: Patients can usually return home the same day or the next day after the procedure, and resume normal activities within a few days.

Minimal side effects: BAE has few side effects, which are usually mild and temporary, such as pain at the injection site, nausea, and fever.

What are the risks?

Depending on your age and current health condition, the following risks and undesirable situations may occur during the procedure. These are generally rare (2-4%) and may include:

1-Chest pain, difficulty in swallowing, usually regress in a short time.

2- Infection: Abscess, sepsis (2%)

3- Ischemia in the embolization area (4%)

4- Occlusion of the non-target site or organ by unintentional embolization (3%).

5- Bleeding

6- Death(%1)

7- Permanent paralysis

8- Contrast agent reactions.

9- Injury at vascular access sites

How can I be treated?

If you apply to the interventional radiology outpatient clinic of our university hospital, your treatment plan will be made. The contact phone number is +90 222 2392979 / to 2860. Our Interventional Radiology secretary will assist you

Frequently asked questions by patients:

1- Is this treatment an experimental treatment?

No. This treatment has now entered the routinely applied guidelines all over the world, is a safe, effective and successful treatment with a high level of patient satisfaction.

2 - When can I take a bath and eat after the procedure?

After the procedure (approximately 3 hours), you can eat and take a bath as soon as you are discharged and go home.

3- Can I start working the next day after the procedure?

If your doctor deems it appropriate and no problem has been encountered, you can start working the next day after the procedure if you wish.

4- When will I fix it?

Generally, a decrease or disappearance of complaints can be observed within a week in the vast majority of patients.

5- Is there anything I should pay attention to when I get home?

It is useful to check the inguinal vein entry area from time to time. Although rare, bleeding may occur from these points. You will be asked to stay away from heavy activities for 1 week. In case of an abnormal situation, you will be asked to apply to the nearest emergency room.