Massive hemoptysis. Selective embolization of bronchial artery-left pulmonary artery fistula. Case resolution

• Published in: REC, Interventional cardiology (Internet. English ed.) Interventional cardiology (Internet. English ed.), 2023-10, Vol.5 (4), p.321-322
• Main Authors: Liberman, Federico, Zaderenko, Nicolás, Pacheco, Guillermo, Casas and, Juan Pablo, Lugones, José
• Format: Article
• Language: English
• ISSN: 2604-7322; 2604-7322
• DOI: 10.24875/RECICE.M22000326

CASE RESOLUTION Emergency transfer of the patient to the cath lab was decided for pulmonary angiography and endovascular embolization. A 5-Fr femoral introducer sheath was used to insert a vertebral catheter with which a largely developed bronchial branch was selectively catheterized (emergency from the aortic arch) towards the pulmonary parenchyma creating a high-flow arterio-arterial fistula with a segmental arterial branch of the lung left upper lobe (video 1 of the supplementary data). Afterwards, a 2.4-Fr (proximal diameter)/1.9-Fr (distal diameter) Echelon 14 microcatheter was passed (Medtronic, United States) through which 2 6 mm × 20 mm Axium Prime 3D detachable coils (Medtronic, United States) were implanted from the distal to the middle third of the bronchial tree (figure 1). The target vessel was successfully embolized resulting in an overt decrease of the cardiac output at fistula level (video 2 of the supplementary data). Procedure was performed uneventfully. After it was completed the amount of vasopressor drugs (noradrenaline and vasopressin) administered was gradually reduced. Forty-eight hours later, the patient was extubated and weaned from mechanical ventilation. Seventy-two hours after the procedure, a follow-up coronary computed tomography angiography confirmed consolidation in the apical and posterior segments of left lower lobe and left perihilar region...