title: Endovascular embolization of bronchial artery originating from the upper portion of aortic arch in patients with massive hemoptysis.
abstract: OBJECTIVE
  Our experience with endovascular embolization (EVE) of the bronchial artery (BA) originating from the upper portion of the aortic arch (AA) in six patients is described.
  
  
  METHODS
  Altogether, 818 patients with hemoptysis underwent multidetector row computed tomography angiography (MDCTA) before EVE or AA angiography during EVE. Aberrant BAs originating from the upper portion of the AA were the source of massive hemoptysis in six patients (0.73 %). MDCT angiograms and/or Digital subtraction angiograms were retrospectively reviewed. Selective catheterization and embolization were performed.
  
  
  RESULTS
  The ostia of the BAs were located on the superior surface of the AA between the brachiocephalic trunk and left common carotid artery in three patients, the junction of the aorta and medial surface of the left subclavian artery in two, and the posterior wall of the upper portion of the AA in one. The six BAs comprised two common trunks, three single right sides, and one single left side. The targeted vessels were successfully catheterized and embolized by a coaxial microcatheter system using polyvinyl alcohol particles. Other pathologic BAs and nonbronchial systemic arteries also were embolized. Bleeding was immediately controlled in all patients with no recurrence of hemoptysis. No procedure-related complications occurred.
  
  
  CONCLUSIONS
  Application of EVE of anomalous origin of BAs in patients with hemoptysis is important, as demonstrated in the six reported patients. MDCTA before EVE or AA angiography during EVE is critical to avoid missing a rare aberrant BA originating from the upper portion of the AA.
authors.affiliation: Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, 200433, China, jasfly77@vip.163.com.
authors.forename: Sen
authors.initials: S
authors.lastname: Jiang
authors.forename: Xi-Wen
authors.initials: XW
authors.lastname: Sun
authors.forename: Dong
authors.initials: D
authors.lastname: Yu
authors.forename: Bing
authors.initials: B
authors.lastname: Jie
mesh_terms: D000328:Adult; D015901:Angiography, Digital Subtraction; D001013:Aorta, Thoracic; D001981:Bronchial Arteries / Q000002:abnormalities* / Q000000981:diagnostic imaging; D003287:Contrast Media; D004621:Embolization, Therapeutic; D006469:Hemoptysis / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D007472:Iohexol; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D007472:Iohexol