1Mohammed Hasan Riyaz,1Alison Graham, 1Alison Graham, 1Ali Alsafi

1Imperial College Healthcare NHS Trust


Haemoptysis refers to bleeding originating from the lower respiratory tract, with the bronchial arteries representing the main source of haemorrhage, followed by the pulmonary arteries, and non-bronchial arterial circulation of the lung. A strong grasp of the anatomy of these arterial systems is required to correctly interpret angiographic studies, perform successful bronchial artery embolization (BAE), and minimise complications.

Material(s) and Method(s):

All patients treated with ER for CMI After preparation of suitable well-experienced iBetween January 2013 and January 2019, eleven patients (4 males and 7 females, mean age: 61.8 years) with dysfunctional 1We present multiple cases demonstrating the angiographic appearances of bronchial arteries, variant anatomy and non-bronchial systemic arterial supply to the lung using examples of BAE procedures performed at our centre.


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The lungs benefit from a dual blood supply; the pulmonary arteries which provide around 99% of the arterial supply, and the bronchial arteries supplying the remaining 1%. The bronchial artery extends along the bronchi and subdivides to supply the numerous supporting structures of the lungs. The origin and supply of the bronchial arteries is variable; in most cases originating from the descending thoracic aorta and less frequently from other vascular territories including the subclavian artery, internal mammary artery, and inferior-phrenic artery… In 5-10% of known cases the intercosto-bronchial artery trunk can branch into the anterior spinal artery, highlighting the need for good angiopathic images and careful assessment of imaging to avoid serious complication during BAE.

In patients with chronic inflammatory lung disease, the inflammatory response can stimulate systemic and pulmonary shunting. The shunting occurs either as a result of dilatation of existing capillary anastomoses (bronchial to pulmonary artery), or neovascularity arising from non-bronchial systemic vessels giving rise to transpleural systemic to pulmonary shunts.

BAE is commonly performed to control moderate volume and massive haemoptysis. While immediate clinical success of BAE is high; recurrence of haemoptysis can occur usually secondary to incomplete embolization, recanalization of previously embolized arteries, and recruitment of new collaterals due to underlying disease progression.


The Outback re-entry device can be safely and effectively used as a bail-out measure in patients whoThe interventional radiologist should be familiar with bronchial artery anatomy, anatomic variants and other systemic arterial supply that is commonly treated in patients presenting with haemoptysis.