Massive hemoptysis. Selective embolization of bronchial artery-left pulmonary artery fistula. How would I approach it?

Abstract

HOW WOULD I APPROACH IT? This is the case of a massive hemoptysis requiring orotracheal intubation where the origin of the hemorrhage can be clearly identified in a fistula from the left bronchial artery—with fistulous trajectory—to the left pulmonary artery upper branch. In view of the situation, and once the patient has been stabilized with right selective intubation, discussion starts on how to save the lung from blood content. Currently, interventional radiology in Spain is available in almost every PCI-capable center meaning that our participation as interventional cardiologists is not required anymore. However, thanks to the «infarction code» network, the geographic availability of cath labs is even greater compared to vascular interventional radiology suites, as it happened to us in our beginnings. In this case, the source of bleeding has already been found, which means we can attempt the catheterization of the bronchial artery right away. Access via pulmonary artery is indicated for cases when the bronchial artery cannot be catheterized. In these cases, it’d be closed with coils as selectively as possible to prevent massive pulmonary infarction from happening.1 Cardiologists have a great variety of devices available to catheterize arteries originate at the aorta like the coronary or bronchial arteries. «Visceral» catheters like the...