The purpose of this study was to analyze the frequency of aberrant and ectopic locations of bleeding arteries. Of the 24 patients who required BAE, 36% had aberrant bronchial origins, and the authors asserted that CTA information guided successful and rapid catheterization in 22 patients and precluded repeated arteriograms. CTA information changed treatment strategy in 2 of the 24 patients with aberrant arteries, resulting in initial treatment with surgical ligation rather than BAE because of an anticipated high risk of Hemoptysis embolization based on vascular location. Mori et al [36] were also early in advocating CTA for preprocedural planning, identifying bronchial artery diameter as an important diagnostic clue on CTA in determining the bleeding artery requiring embolization. Jiang et al [37] reported results from 818 patients obtaining a CTA for preprocedural BAE planning, which isolated 6 aberrant arteries that would not have been detected by standard angiographic procedures. Lin et al [38] also reported a high concordance rate between CTA and conventional arteriography, reporting that 107 of the 110 arteries embolized (97%) were prospectively identified on CTA. This article noted that CTA was useful in both identifying the number of vessels involved in hemoptysis as well as identifying collateral vessels and shunts that increase the risk of complications during arterial embolization. As discussed in the section above, approximately 10% of massive hemoptysis is due to a pulmonary arterial source, which can be occult on bronchial arteriography. Khalil et al [25] retrospectively reviewed 272 patients, 13 of whom had bleeding from a pulmonary artery origin. Of these 13 patients, 8 were initially and successfully treated with pulmonary artery embolization based on the CTA findings, and 3 more patients were subsequently imaged and successfully treated with pulmonary artery embolization after BAE failed to treat the hemoptysis. This study highlighted CTA guiding embolization therapy.
Hemoptysis. The purpose of this study was to analyze the frequency of aberrant and ectopic locations of bleeding arteries. Of the 24 patients who required BAE, 36% had aberrant bronchial origins, and the authors asserted that CTA information guided successful and rapid catheterization in 22 patients and precluded repeated arteriograms. CTA information changed treatment strategy in 2 of the 24 patients with aberrant arteries, resulting in initial treatment with surgical ligation rather than BAE because of an anticipated high risk of Hemoptysis embolization based on vascular location. Mori et al [36] were also early in advocating CTA for preprocedural planning, identifying bronchial artery diameter as an important diagnostic clue on CTA in determining the bleeding artery requiring embolization. Jiang et al [37] reported results from 818 patients obtaining a CTA for preprocedural BAE planning, which isolated 6 aberrant arteries that would not have been detected by standard angiographic procedures. Lin et al [38] also reported a high concordance rate between CTA and conventional arteriography, reporting that 107 of the 110 arteries embolized (97%) were prospectively identified on CTA. This article noted that CTA was useful in both identifying the number of vessels involved in hemoptysis as well as identifying collateral vessels and shunts that increase the risk of complications during arterial embolization. As discussed in the section above, approximately 10% of massive hemoptysis is due to a pulmonary arterial source, which can be occult on bronchial arteriography. Khalil et al [25] retrospectively reviewed 272 patients, 13 of whom had bleeding from a pulmonary artery origin. Of these 13 patients, 8 were initially and successfully treated with pulmonary artery embolization based on the CTA findings, and 3 more patients were subsequently imaged and successfully treated with pulmonary artery embolization after BAE failed to treat the hemoptysis. This study highlighted CTA guiding embolization therapy.