Bronchial artery embolization (BAE) is a minimally invasive procedure used to control massive or recurrent hemoptysis by occluding the blood supply from abnormal bronchial vessels. It involves catheterizing the bronchial arteries under imaging guidance and injecting embolic agents like particles or coils to cut off the blood flow. BAE has success rates of 64-100% for immediate bleeding control and is preferred over surgery due to lower risks, especially in high-risk patients. Potential complications include recurrence of bleeding from collateral vessels or reopening of embolized arteries, and rarely, spinal cord damage from unintended embolization of critical radiculomedullary branches.
USMLE CVS 005 Blood vessels – Arteries and veins.pdfAHMED ASHOUR
The major blood vessels in the human body form an extensive network that facilitates the transportation of blood, oxygen, and nutrients to various tissues and organs.
Understanding the anatomy and function of major blood vessels is essential for comprehending the circulatory system and diagnosing and treating cardiovascular conditions.
1. Bronchial artery embolization is an effective minimally invasive treatment for massive or recurrent hemoptysis, with clinical success rates of 85-100% and recurrence rates of 10%.
2. The document describes the technique, complications, and outcomes of bronchial artery embolization based on a case series of 9 patients treated for hemoptysis.
3. When performing bronchial artery embolization, special care must be taken to avoid embolizing arteries supplying the spinal cord, as this could result in spinal cord ischemia.
The document summarizes the major arteries of the head and neck, including their embryological development, course, branches, and clinical significance. It describes the carotid system, internal carotid artery, and external carotid artery in detail. Key branches discussed include the superior thyroid, lingual, facial, and maxillary arteries. Variations in artery origins are also noted.
A 50-year-old woman presented with worsening shortness of breath, cough, haemoptysis and weight loss over 3 months. CT scan showed a large superior mediastinal mass encasing blood vessels and the right main bronchus, with lymph node involvement. Biopsy of a neck lymph node confirmed small cell lung cancer. The patient's symptoms worsened and she was admitted as an emergency. Radiation, chemotherapy, surgery and stents are treatments for superior vena cava obstruction, with the approach depending on factors like tumor type, extent of disease, and performance status. Relief of symptoms is often seen within days of starting treatment.
Mediastinoscopy is a procedure used to sample mediastinal lymph nodes through a cervical incision. It allows access to lymph node stations 2R, 2L, 4R, 4L, and 7. Complications can include bleeding, esophageal perforation, nerve injury, and pneumothorax. Indications include staging lung cancer and evaluating mediastinal lymphadenopathy. Proper patient evaluation and hemostasis are important to minimize risks.
The document summarizes the arterial blood supply and venous drainage of the brain and spinal cord. It notes that the brain has high metabolic demands for oxygen and glucose due to its high metabolic activity. It then describes the major arteries that supply the brain, including the internal carotid and vertebral arteries, as well as branches like the anterior, middle and posterior cerebral arteries. It discusses the circle of Willis and its role in connecting these arteries. It also summarizes venous drainage patterns and structures like dural venous sinuses. Finally, it briefly outlines the arterial supply and venous drainage of the spinal cord.
radiology Arterial and venous supply of brain neuroimaging part 1Sameeha Khan
The document discusses the anatomy and imaging of cerebral vasculature. It begins by covering the major vessels arising from the aortic arch, including the brachiocephalic trunk, right and left common carotid arteries, and right subclavian artery. It then details the branches and course of the external carotid artery. The remainder discusses the segments and branches of the internal carotid artery as it passes through the petrous, cavernous, and supraclinoid regions. Key branches include the ophthalmic artery and inferior hypophyseal artery. Various angiographic views and MRI/CT techniques for visualizing these vessels are also summarized.
The document discusses cardiovascular anatomy and physiology. It describes the structures of the heart including the layers (pericardium, epicardial fat, myocardium, endocardium), chambers (left and right atria and ventricles), and valves. It also discusses the cardiac conduction system including the sinoatrial node, atrioventricular node, bundle of His, and Purkinje fibers. Hemodynamic monitoring techniques are covered such as intra-arterial blood pressure monitoring, central venous pressure monitoring, pulmonary artery pressure monitoring, and mixed venous oxygen saturation monitoring. Physical exam skills related to cardiovascular assessment are also outlined.
USMLE CVS 005 Blood vessels – Arteries and veins.pdfAHMED ASHOUR
The major blood vessels in the human body form an extensive network that facilitates the transportation of blood, oxygen, and nutrients to various tissues and organs.
Understanding the anatomy and function of major blood vessels is essential for comprehending the circulatory system and diagnosing and treating cardiovascular conditions.
1. Bronchial artery embolization is an effective minimally invasive treatment for massive or recurrent hemoptysis, with clinical success rates of 85-100% and recurrence rates of 10%.
2. The document describes the technique, complications, and outcomes of bronchial artery embolization based on a case series of 9 patients treated for hemoptysis.
3. When performing bronchial artery embolization, special care must be taken to avoid embolizing arteries supplying the spinal cord, as this could result in spinal cord ischemia.
The document summarizes the major arteries of the head and neck, including their embryological development, course, branches, and clinical significance. It describes the carotid system, internal carotid artery, and external carotid artery in detail. Key branches discussed include the superior thyroid, lingual, facial, and maxillary arteries. Variations in artery origins are also noted.
A 50-year-old woman presented with worsening shortness of breath, cough, haemoptysis and weight loss over 3 months. CT scan showed a large superior mediastinal mass encasing blood vessels and the right main bronchus, with lymph node involvement. Biopsy of a neck lymph node confirmed small cell lung cancer. The patient's symptoms worsened and she was admitted as an emergency. Radiation, chemotherapy, surgery and stents are treatments for superior vena cava obstruction, with the approach depending on factors like tumor type, extent of disease, and performance status. Relief of symptoms is often seen within days of starting treatment.
Mediastinoscopy is a procedure used to sample mediastinal lymph nodes through a cervical incision. It allows access to lymph node stations 2R, 2L, 4R, 4L, and 7. Complications can include bleeding, esophageal perforation, nerve injury, and pneumothorax. Indications include staging lung cancer and evaluating mediastinal lymphadenopathy. Proper patient evaluation and hemostasis are important to minimize risks.
The document summarizes the arterial blood supply and venous drainage of the brain and spinal cord. It notes that the brain has high metabolic demands for oxygen and glucose due to its high metabolic activity. It then describes the major arteries that supply the brain, including the internal carotid and vertebral arteries, as well as branches like the anterior, middle and posterior cerebral arteries. It discusses the circle of Willis and its role in connecting these arteries. It also summarizes venous drainage patterns and structures like dural venous sinuses. Finally, it briefly outlines the arterial supply and venous drainage of the spinal cord.
radiology Arterial and venous supply of brain neuroimaging part 1Sameeha Khan
The document discusses the anatomy and imaging of cerebral vasculature. It begins by covering the major vessels arising from the aortic arch, including the brachiocephalic trunk, right and left common carotid arteries, and right subclavian artery. It then details the branches and course of the external carotid artery. The remainder discusses the segments and branches of the internal carotid artery as it passes through the petrous, cavernous, and supraclinoid regions. Key branches include the ophthalmic artery and inferior hypophyseal artery. Various angiographic views and MRI/CT techniques for visualizing these vessels are also summarized.
The document discusses cardiovascular anatomy and physiology. It describes the structures of the heart including the layers (pericardium, epicardial fat, myocardium, endocardium), chambers (left and right atria and ventricles), and valves. It also discusses the cardiac conduction system including the sinoatrial node, atrioventricular node, bundle of His, and Purkinje fibers. Hemodynamic monitoring techniques are covered such as intra-arterial blood pressure monitoring, central venous pressure monitoring, pulmonary artery pressure monitoring, and mixed venous oxygen saturation monitoring. Physical exam skills related to cardiovascular assessment are also outlined.
Imaging in pulmonary circulation diseaseMilan Silwal
This document discusses various pulmonary circulation diseases and their imaging appearances. It begins with an overview of pulmonary circulation anatomy and physiology. It then discusses several conditions in more detail:
1) Pulmonary venous hypertension which appears on imaging as interstitial edema, pleural effusions, and alveolar edema in advanced stages.
2) Pulmonary arterial hypertension which is characterized by enlarged pulmonary arteries, pruning of peripheral vessels, and right ventricular strain on imaging.
3) Pulmonary arteriovenous malformations which appear as round opacities on imaging and may cause paradoxical embolism.
4) Pulmonary embolism which most commonly presents as small thrombi in the lung periphery and is diagnosed
Venous Supply of head, neck and face ish.pptxishwaryar19
The document provides an overview of the venous drainage of the head and neck. It begins with an introduction to the venous system and embryology. It then describes the major veins of the head and neck region under several sections - exterior head and neck veins, cervical veins, and cranial/intracranial veins. Key veins discussed include the facial vein, maxillary vein, retromandibular vein, external and internal jugular veins, and dural venous sinuses. Clinical applications of venous anatomy are also noted.
emergency echo in critically ill patients.pptShivani Rao
Emergency echocardiography provides rapid assessment of cardiac function and physiology in critically ill patients with shock. A goal-directed echocardiogram should evaluate for pericardial effusion, left ventricular contractility, and right ventricular dilation. Key findings include cardiac tamponade, pulmonary embolism, and acute pump failure. Echocardiography can also identify pneumothorax, assess volume status, and rule out aortic dissection or DVT as potential causes of shock. It is a valuable tool for point-of-care decision making in critically ill patients.
USMLE CVS 001 Mediastinum anatomy medical chest .pdfAHMED ASHOUR
The mediastinum is the central compartment of the thoracic cavity, located between the lungs.
It is a three-dimensional space that houses various structures within the chest.
The mediastinum extends from the sternum (front of the chest) to the vertebral column (back of the chest) and from the superior thoracic aperture (top of the chest) to the diaphragm (bottom of the chest).
Understanding the anatomy of the mediastinum is crucial for healthcare professionals to interpret diagnostic findings and manage conditions affecting this central compartment of the thoracic cavity.
1. Extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT) are important life support therapies used in intensive care units.
2. ECMO uses an external circuit to oxygenate blood and remove carbon dioxide, functioning as a bridge to recovery, transplant, or decision. CRRT slowly removes waste and fluid from the blood of patients with kidney failure or injury.
3. The document discusses the principles, indications, techniques, and complications of ECMO and CRRT, highlighting their roles in supporting critically ill patients with cardiac, respiratory, or renal issues.
Arteriography and interventional radiologyMilan Silwal
Angiography involves the radiologic examination of blood vessels after injection of iodinated contrast medium. Arteriography specifically examines arteries, while venography examines veins. Techniques include non-invasive ultrasound and MRI, minimally invasive CT or MRI with contrast, and invasive catheterization. Catheters and guide wires are used to access vessels and inject contrast medium. Potential complications include contrast reactions, embolism, infection, and vessel damage. Indications for arteriography include evaluating congenital anomalies, aneurysms, stenoses, arteritis, trauma, embolism, vascular malformations, fistulas, hemorrhage, and masses.
MI ( blockage of blood flow to heart muscle)
Acute angina (type of chest pain)
Aneurysms
AVM( Arterio-venous Malformations) abnormal connection between artery and vein.
eg. In spine and brain.
AVF (Arterio-venous Fistulas), LCA ,RCA EQUIPMENT
RUKAMANEE YADAV
Anatomy and imaging of coronary artery disease withSarbesh Tiwari
1) Coronary CT angiography (CCTA) uses computed tomography to non-invasively image the coronary arteries. It provides high quality images of the coronary arteries and their branches.
2) CCTA is performed using either electron-beam CT or multi-detector row CT (MDCT). MDCT is now more commonly used due to its wider availability and lower cost. The latest generation 64-detector MDCT allows for very high resolution imaging.
3) CCTA requires careful preparation of the patient including medication to control heart rate and dilation of the coronary arteries. The scan itself involves ECG gating to image the heart during diastasis and injection of iodinated contrast to outline the coronary
Contrast echocardiography uses microbubbles to enhance ultrasound visualization of cardiac structures. It has several clinical uses including detecting intracardiac shunts, assessing left ventricular function, and evaluating myocardial perfusion. The document discusses the principles behind contrast echocardiography, indications, contraindications, techniques, and examples of its use in evaluating various cardiac abnormalities like atrial septal defects. Safety of the procedure is also reviewed, noting the risks of saline-based contrast versus newer commercially developed agents.
The document discusses the anatomy of cerebral veins and their application in cerebral venous thrombosis (CVT). It begins with an overview of the anatomy of cerebral veins, including superficial veins that drain the cortical surfaces and deep veins that drain the deep white and gray matter. It then describes the dural sinuses and veins that receive blood from the cerebral veins, such as the superior sagittal sinus, straight sinus, transverse sinus, and cavernous sinus. The document then discusses CVT, noting that it involves thrombosis of cerebral veins and draining venous sinuses. It provides information on the epidemiology, risk factors, clinical presentations, diagnosis, and treatment of CVT.
The document discusses the anatomy of cerebral veins and its application in cerebral venous thrombosis (CVT). It begins with an overview of the anatomy of cerebral veins, including superficial cerebral veins that drain the cortical surfaces and deep cerebral veins that drain deep white and gray matter. It then discusses dural sinuses and veins that receive cerebral veins, such as the superior and inferior sagittal sinuses, straight sinus, transverse sinus, and cavernous sinus. The document then covers CVT epidemiology, risk factors, clinical presentations, diagnosis, and treatment, focusing on puerperal CVT specifically. Puerperal CVT is more common in India than Western countries and its incidence has decreased in recent decades due to improved obst
This document discusses the neurovasculature of the heart. It describes the coronary arteries including the right and left coronary arteries, their typical branches and variations. It discusses coronary artery disease including causes, symptoms, diagnosis and treatments such as coronary angiography. It also summarizes the conduction system of the heart including the sinoatrial and atrioventricular nodes, the pathways of electrical conduction and the basics of an electrocardiogram. Additionally, it outlines the venous drainage of the heart and lymphatic drainage. Artificial pacing of the heart with pacemakers is also briefly described.
1. The document discusses the anatomy and epidemiology of carotid atherosclerotic disease. It describes the anatomy of the aortic arch and its branches, including the common, external, and internal carotid arteries.
2. Pathophysiology sections cover the development of atherosclerosis in the carotid bulb and mechanisms by which plaques can cause TIAs or strokes via embolization and hypoperfusion.
3. Evaluation and management are discussed, including use of carotid duplex ultrasound, CTA, MRA, and angiography to diagnose stenosis. Medical management focuses on risk factor modification including smoking cessation and diabetes control.
The blood vessels of the upper limb include arteries and veins that supply and drain blood from the various regions of the arm, forearm, hand, and fingers. Understanding the anatomy of these vessels is crucial for medical professionals performing procedures such as venipuncture, vascular surgery, or assessing blood flow to the upper limb.
The veins play a crucial role in returning deoxygenated blood from the upper limb back to the heart.
This document discusses the case of a 4-month-old baby boy diagnosed with a weak and dilated heart at 32 days old. Echocardiography revealed dilated ventricles and a continuous murmur. Further imaging with CT scan diagnosed the patient with left lower lobe intralobar pulmonary sequestration, where part of the lung receives anomalous arterial blood supply directly from the aorta. Pulmonary sequestration is a rare congenital anomaly where non-functioning lung tissue has its own blood supply, and can cause infections, heart failure, or failure to thrive if left untreated. Surgical excision is usually curative for symptomatic patients.
The document discusses the blood supply of the lungs, which includes the bronchial circulation and pulmonary circulation.
The bronchial circulation supplies oxygenated blood to the bronchi and lungs from the systemic circulation. The pulmonary circulation supplies deoxygenated blood from the right ventricle to the lungs where gas exchange occurs in the pulmonary capillaries before oxygenated blood returns to the left atrium.
The document provides details on the development, anatomy, pressures, and functions of both the bronchial and pulmonary circulations in fetal, neonatal and adult stages. It also discusses factors that regulate pulmonary vascular resistance and the role of the pulmonary circulation in gas exchange, filtering blood, and acting as a reservoir for the left vent
The document provides an overview of cardiac surgery and the anatomy of the heart. It describes the shape and borders of the heart as well as the chambers and valves. It then discusses the coronary arteries and dominance. It provides details on cardiopulmonary bypass, including the circuit and components. It lists alternative uses of CPB. It also summarizes the main methods of myocardial protection during surgery, including cardioplegic arrest and intermittent clamping. Finally, it outlines some common incisions used for cardiac surgery like median sternotomy and thoracotomies.
This document discusses imaging techniques for evaluating obstructive jaundice. It begins by describing jaundice and its causes, including prehepatic, hepatic, and post-hepatic (obstructive) etiologies. For obstructive jaundice, imaging plays a key role in identifying the level and cause of obstruction. Ultrasound is often the initial study, while CT, MRCP, ERCP, and intraoperative ultrasound may provide additional information. The document outlines various imaging techniques and their abilities to characterize common causes of obstruction like stones, strictures, and malignancies. It emphasizes the importance of determining the presence, level, and cause of obstruction to guide management.
The document discusses Triple Rule Out CT (TRO-CT), which is a CT exam that evaluates the coronary arteries, pulmonary arteries, and aorta to diagnose causes of acute chest pain. TRO-CT is appropriate when there is suspicion of acute coronary syndrome along with pulmonary embolism or acute aortic syndrome. It describes the anatomy of the aorta, pulmonary arteries, and coronary arteries. It also discusses common causes of chest pain related to the heart, lungs, chest wall, and digestion. The criteria and exclusion criteria for TRO-CT are provided.
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Imaging in pulmonary circulation diseaseMilan Silwal
This document discusses various pulmonary circulation diseases and their imaging appearances. It begins with an overview of pulmonary circulation anatomy and physiology. It then discusses several conditions in more detail:
1) Pulmonary venous hypertension which appears on imaging as interstitial edema, pleural effusions, and alveolar edema in advanced stages.
2) Pulmonary arterial hypertension which is characterized by enlarged pulmonary arteries, pruning of peripheral vessels, and right ventricular strain on imaging.
3) Pulmonary arteriovenous malformations which appear as round opacities on imaging and may cause paradoxical embolism.
4) Pulmonary embolism which most commonly presents as small thrombi in the lung periphery and is diagnosed
Venous Supply of head, neck and face ish.pptxishwaryar19
The document provides an overview of the venous drainage of the head and neck. It begins with an introduction to the venous system and embryology. It then describes the major veins of the head and neck region under several sections - exterior head and neck veins, cervical veins, and cranial/intracranial veins. Key veins discussed include the facial vein, maxillary vein, retromandibular vein, external and internal jugular veins, and dural venous sinuses. Clinical applications of venous anatomy are also noted.
emergency echo in critically ill patients.pptShivani Rao
Emergency echocardiography provides rapid assessment of cardiac function and physiology in critically ill patients with shock. A goal-directed echocardiogram should evaluate for pericardial effusion, left ventricular contractility, and right ventricular dilation. Key findings include cardiac tamponade, pulmonary embolism, and acute pump failure. Echocardiography can also identify pneumothorax, assess volume status, and rule out aortic dissection or DVT as potential causes of shock. It is a valuable tool for point-of-care decision making in critically ill patients.
USMLE CVS 001 Mediastinum anatomy medical chest .pdfAHMED ASHOUR
The mediastinum is the central compartment of the thoracic cavity, located between the lungs.
It is a three-dimensional space that houses various structures within the chest.
The mediastinum extends from the sternum (front of the chest) to the vertebral column (back of the chest) and from the superior thoracic aperture (top of the chest) to the diaphragm (bottom of the chest).
Understanding the anatomy of the mediastinum is crucial for healthcare professionals to interpret diagnostic findings and manage conditions affecting this central compartment of the thoracic cavity.
1. Extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT) are important life support therapies used in intensive care units.
2. ECMO uses an external circuit to oxygenate blood and remove carbon dioxide, functioning as a bridge to recovery, transplant, or decision. CRRT slowly removes waste and fluid from the blood of patients with kidney failure or injury.
3. The document discusses the principles, indications, techniques, and complications of ECMO and CRRT, highlighting their roles in supporting critically ill patients with cardiac, respiratory, or renal issues.
Arteriography and interventional radiologyMilan Silwal
Angiography involves the radiologic examination of blood vessels after injection of iodinated contrast medium. Arteriography specifically examines arteries, while venography examines veins. Techniques include non-invasive ultrasound and MRI, minimally invasive CT or MRI with contrast, and invasive catheterization. Catheters and guide wires are used to access vessels and inject contrast medium. Potential complications include contrast reactions, embolism, infection, and vessel damage. Indications for arteriography include evaluating congenital anomalies, aneurysms, stenoses, arteritis, trauma, embolism, vascular malformations, fistulas, hemorrhage, and masses.
MI ( blockage of blood flow to heart muscle)
Acute angina (type of chest pain)
Aneurysms
AVM( Arterio-venous Malformations) abnormal connection between artery and vein.
eg. In spine and brain.
AVF (Arterio-venous Fistulas), LCA ,RCA EQUIPMENT
RUKAMANEE YADAV
Anatomy and imaging of coronary artery disease withSarbesh Tiwari
1) Coronary CT angiography (CCTA) uses computed tomography to non-invasively image the coronary arteries. It provides high quality images of the coronary arteries and their branches.
2) CCTA is performed using either electron-beam CT or multi-detector row CT (MDCT). MDCT is now more commonly used due to its wider availability and lower cost. The latest generation 64-detector MDCT allows for very high resolution imaging.
3) CCTA requires careful preparation of the patient including medication to control heart rate and dilation of the coronary arteries. The scan itself involves ECG gating to image the heart during diastasis and injection of iodinated contrast to outline the coronary
Contrast echocardiography uses microbubbles to enhance ultrasound visualization of cardiac structures. It has several clinical uses including detecting intracardiac shunts, assessing left ventricular function, and evaluating myocardial perfusion. The document discusses the principles behind contrast echocardiography, indications, contraindications, techniques, and examples of its use in evaluating various cardiac abnormalities like atrial septal defects. Safety of the procedure is also reviewed, noting the risks of saline-based contrast versus newer commercially developed agents.
The document discusses the anatomy of cerebral veins and their application in cerebral venous thrombosis (CVT). It begins with an overview of the anatomy of cerebral veins, including superficial veins that drain the cortical surfaces and deep veins that drain the deep white and gray matter. It then describes the dural sinuses and veins that receive blood from the cerebral veins, such as the superior sagittal sinus, straight sinus, transverse sinus, and cavernous sinus. The document then discusses CVT, noting that it involves thrombosis of cerebral veins and draining venous sinuses. It provides information on the epidemiology, risk factors, clinical presentations, diagnosis, and treatment of CVT.
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2. Pathophysiology sections cover the development of atherosclerosis in the carotid bulb and mechanisms by which plaques can cause TIAs or strokes via embolization and hypoperfusion.
3. Evaluation and management are discussed, including use of carotid duplex ultrasound, CTA, MRA, and angiography to diagnose stenosis. Medical management focuses on risk factor modification including smoking cessation and diabetes control.
The blood vessels of the upper limb include arteries and veins that supply and drain blood from the various regions of the arm, forearm, hand, and fingers. Understanding the anatomy of these vessels is crucial for medical professionals performing procedures such as venipuncture, vascular surgery, or assessing blood flow to the upper limb.
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3. Two Circulations in the Lung
• Bronchial Circulation
– Arises from the aorta.
– Part of systemic circulation.
– Receives about 2% of left
ventricular output.
• Pulmonary Circulation
– Arises from Right Ventricle.
– Receives 100% of blood flow.
4.
5. ANATOMICAL CONSIDERATION-
Bronchial Artery
Variable anatomy in terms of origin, branching
pattern, and course.
Bronchial arteries usually arise as a pair or as a
common trunk, from the descending thoracic aorta
below the origin of left subclavian artery.
The standard or orthotopic origin is from the aorta
between the levels of T5 and T6 (80%).
ANOMALOUS – Outside the levels of T5 and T6 .
ANOMALOUS - Aortic arch, Internal mammary artery,
Thyrocervical trunk, Subclavian, Costocervical trunk,
Pericardicophrenic artery, Inferior phrenic artery.
6. BRONCHIAL CIRCULATION
Sometimes part of blood supply of anterior spinal
artery come from bronchial vessels.
When bronchial artery embolization is
performed, consideration must be given to the
arterial supply to the spinal cord.
Most important is Anterior Spinal Artery.
Anterior spinal artery receives contributions from
the anterior radiculo medullary branches of the
intercostals and lumbar arteries.
7. ARTERY OF ADAMKIEWICZ
The largest anterior medullary
branch.
Has variable origin from T5 –L5
level, but most commonly from
T8 – L1 level.
In 5 % of population Rt. IBT
contributes to artery of
Adamkiewicz.
The left bronchial arteries very
rarely contribute the anterior
spinal artery.
9. Bronchial artery branching pattern
Cauldwell et al - four patterns:
Type I
Type II
Type III
Type IV
Cauldwell EW, Siekert RG, Lininger RE, Anson BJ.The bronchial arteries: an
anatomic study of 105 human cadavers. Surg Gynecol Obstet 1948; 86:395–
412.
10. Type I
• Incidence: 40.6%
• Left:2
• Right:1
{intercostobronchial
trunk (ICBT)}
11.
12.
13.
14. Bronchial Artery- Course
Leave the aorta at an upward
angle, against the direction of
blood flow.
Send braches to oesophagus,
mediastinum, lymph nodes and
nerves.
On reaching the main bronchi
divide into visceral pleural
branches to the mediastinal
pleura and true bronchial
arteries to the bronchial tree.
15. Bronchial Artery- Course
Spiral course around bronchi, one on either side of
each other but anastomosing frequently with each
other
The vessels form an arterial plexus in the adventitia
from which branches pierce the muscle layer to enter
the submucosa, where they break up into capillary
plexus.
Supplies bronchi, nerves, walls of pulmonary vessels
and intra pulmonary lymph nodes.
16. Bronchial Artery- Course
Arteriolar branches of the
visceral pleural vessels pass
along interlobular septa,
reaching the interstitial tissue of
the lung acinus.
The true bronchial arteries
reach as far down the airways as
the terminal bronchiole.
Much of the bronchial arterial
blood, having gone through the
submucosal capillaries, passes
into the venous plexus in the
adventitia.
Veins from this plexus then join
pulmonary venous system.
17. Bronchial Artery
Embolization
Minimally invasive alternative to
surgery.
selective bronchial artery
catheterization and angiography,
followed by embolization of any
identified abnormal vessels to
stop the bleeding.
Considered to be the most
effective nonsurgical treatment
in the management of massive
and recurrent hemoptysis.
18. Bronchial Artery Embolization
First by Remy et al. in 1973.*
Temporary or definitive
Immediate control: 57–100% of patients**
Embolization : bronchial and nonbronchial
Long-term control: 70%-88%
Remy J, Voisin C, Dupuis C, et al: Traitement des hémoptysies par embolisation de la circulation systémique. Ann
Radiol (Paris) 1974; 17: 5–16.
**Remy J, Arnaud A, Fardou H, et al: Treatment of hemoptysis by embolization of bronchial arteries.
Radiology 1977; 122: 33–37.
20. Indications
Managing ruptured pulmonary artery venous
malformation.
To Stabilize patients before surgical resection or
medical treatment.
As a definitive therapeutic approach in patients:
-Who refuse surgery
-Who are not candidates for surgery
-Where surgery is contraindicated
Bronchial artery embolization: Managing ruptured pulmonary artery venous
malformation e A case report Dharitri Goswami a,*, Shantanu Das b,1, Ashok
Parida c,2, Joy Sanyal c,3. Respiratory Medicine CME 4 (2011) 160e163
poor lung function, bilateral pulmonary disease, co morbidities.
21. WHY BAE ??
1)Bronchial circulation (90% of cases)
- Pulmonary circulation (5%) .
- Aorta (5%)(eg, aorto bronchial fistula,
ruptured aortic aneurysm).
2) Surgery
- Mortality 18% when performed
electively, rising to 40% when performed
emergently.
- conservative approach , mortality risk of at
least 50%.
3) Minimally invasive
- clinical success - 85% to 100%,
- recurrence of hemorrhage – 10%.
22. BAE- TECHNIQUE
Prior to the procedure, a brief neurological exam is
performed to establish a baseline.
Femoral route/Trans-Axillary route
Monitor vitals/spo2
Sedation optional
Clean groin with antiseptics.
Adequate LA
A preliminary descending thoracic aortogram
(Ionic/non ionic contrast) can be performed as a
roadmap to the bronchial arteries.
23. BAE - TECHNIQUE
Both bronchial arteries and nonbronchial systemic
arteries are opacified.
The diagnostic angiographic injections are always
selective into the bronchial, intercostals, subclavian,
internal mammary, intercostobronchial, and inferior
phrenic arteries.
Under X-Ray machine guidance (Digital cardiac imaging
with digital subtraction facility)
Reverse curve catheter – mikaelsson, simmons 1,
shepherd’s hook.
Low arotic arch – forward looking catheters ( cobra or RC
) used.
24. Angiographic signs of haemoptysis
ISRN Vascular Medicine Volume 2013, Article ID 263259, 7 pages
25. BAE - TECHNIQUE
The left main stem
bronchus serves as a
convenient fluoroscopic
landmark for the general
location of the bronchial
arteries
The catheter is directed
lateral or anterolateral for
the right bronchial and
more anterior for the left.
Bronchial arteries – course
of main stem bronchi
towards hila.
Intercostal arteries – initial
cephalic course , then
laterally along undersurface
of rib
26. BAE - TECHNIQUE
The embolization materials commonly used
are non-absorbable particles of polyvinyl
alcohol (PVA) (Ivalon; Nycomed SA; Paris,
France), 355–500 𝜇m in size (some larger
vessels required particles as large as 2 mm),
and fibred platinum coils of 2 and 3mm in size
(MicroNester Embolization Coils; Cook,
Bjaeverskov, Denmark).
32. Embolizing materials:
Particles > 200 to 250 micr.m should be used
No ischaemia and no neurologic damage
Isobutyl-2 cyanoacrolate, Absolute alcohol
Used in pulmonary artery aneurysms
to avoid tissue ischemia and neurologic
damage
33. Embolizing materials:
Distal embolization : ideal
Proximal occlusion: temporary relief
particles < 200 micr.m :avoided
-Tissue infarction
Liquid embolic agents should always be
avoided because these cause tissue
infarction
34. Clues to bronchial artery as the source of
bleeding:
34
Parenchymal hypervascularity
Vascular hypertrophy
aneurysm
35. 35
The identification of extravasated
dye --INFREQUENT
Bronchopulmonary shunting
Neovascularisation
36. Left upper lobe bronchial artery
After Embolization
Decreased vascularity & hypertrophy
Tortous and hypertrophied vessel
Before Embolization
39. Super selective Embolization of
intercostal artery
Hypervascular areas and a small amount of
pulmonary arterial shunting
Decreased vasularity
POST EMBOLIZATION
PRE EMBOLIZATION
Radicular arteries
INTERCOSTAL ARTERY
Micro catheter passed
beyond radicular artery
40. Bronchial Artery Embolization
Success rates : 64% to 100%.
Recurrent non-massive bleeding :16–46%
• Recurrence of haemoptysis may be due to:
Incomplete embolization of the bronchial
vessels
Recannalization of the embolized arteries.
Presence of non-bronchial systemic arteries.
Development of collateral circulation in
response to continuing pulmonary
inflammation.
41. Bronchial Artery Embolization
Technical failure: 13%
Technical failure is caused by non-bronchial artery
collaterals from systemic vessels such as the phrenic,
intercostal, mammary,(PLEURA) or subclavian
Arteries.
42. Complications of BAE
• Transversemyelitis
The most feared complication
due to non target occlusion of
branches.
When the anterior spinal
artery is identified as
originating from the bronchial
artery, embolisation is often
deferred owing to the risk of
infaction and paraparesis.
43. The anterior spinal artery is the blood vessel that
supplies the anterior portion of the spinal cord.
It arises from branches of the vertebral arteries and is
supplied by the anterior segmental medullary arteries,
including the artery of Adamkiewicz, and courses along
the anterior aspect of the spinal cord.
Disruption of the anterior spinal cord leads to bilateral
disruption of the corticospinal tract, causing motor
deficits, and bilateral disruption of the spinothalamic
tract, causing sensory deficits in the form of
pain/temperature sense loss
Complications of BAE
45. Complications of BAE
Chest pain is the most common
complication.
Dysphagia due to embolization of
esophageal branches may also be
encountered.
• Rare complications
Aortic and bronchial necrosis
Bronchoesophageal fistula
Non–target organ embolization (eg,
ischemic colitis)
Pulmonary infarction.
46. References
1) Haponik E F, Fein A, Chin R. Managing life-
threatening hemoptysis: has anything really
changed? Chest. 2000;118(5):1431–1435.
2)Shigemura N, Wan I Y, Yu S C, et al.
Multidisciplinary management of life-
threatening massive hemoptysis: a 10-year
experience. Ann Thorac Surg. 2009;87(3):849–
853.
3)Marshall T J, Jackson J E. Vascular
intervention in the thorax: bronchial artery
embolization for haemoptysis. Eur Radiol.
1997;7(8):1221–1227.
47. 4)Yoon W, Kim J K, Kim Y H, Chung T W, Kang
H K. Bronchial and nonbronchial systemic
artery embolization for life-threatening
hemoptysis: a comprehensive review.
Radiographics. 2002;22(6):1395–1409.
5)Fernando H C, Stein M, Benfield J R, Link D
P. Role of bronchial artery embolization in
the management of hemoptysis. Arch Surg.
1998;133(8):862–866
6)Ramakantan R, Bandekar V G, Gandhi M S,
Aulakh B G, Deshmukh H L. Massive
hemoptysis due to pulmonary tuberculosis:
control with bronchial artery embolization.
Radiology. 1996;200(3):691–694.
References
48. CONCLUSION
1) The development of bronchial
artery embolization techniques has
revolutionized the approach to
hemoptysis patients.
2) Bronchial artery embolization
possesses high rates of immediate
clinical success coupled with low
complication rates.
3) When bronchial artery
angiography and embolization is
performed, consideration must be
given to the arterial supply to the
spine.
49. 4) Surgery should be considered
only in case where embolisation
is not possible due technical
difficulty and in case of
embolisation failure. Otherwise
bronchial artery embolisation is
considered as the mainstay
treatment for hemoptysis.
CONCLUSION