Endovascular treatment of ectopic bronchial artery aneurysm with brachiocephalic artery stent placement and coil embolization: A case report and literature review

Abstract

Background: Bronchial artery aneurysm (BAA) is an uncommon but potentially life-threatening disease, and multiple BAAs are even rarer. Clinically, the tortuous and short neck of a BAA may present significant challenges for invasive intervention.

Methods: This report describes the detailed process of diagnosis and treatment and includes a literature review of the etiology, clinical presentation, and therapeutic management of BAA.

Results: A rare case of multiple BAAs, with one having an inflow artery arising from the brachiocephalic trunk, was referred to our hospital. The patient was successfully treated with coil embolization and brachiocephalic artery stent placement. In addition, we conducted a literature review involving 63 cases of BAA. BAA was most commonly associated with bronchiectasis and was located predominantly in the mediastinum. There was no significant difference between the diameters of the ruptured aneurysms and those of the nonruptured aneurysms (P = 0.115). Transcatheter arterial embolization was the most commonly adopted technique to treat BAA, while thoracic aortic endovascular repair was selected if the neck between the aneurysm and the aorta was short. Subgroup analysis suggested that patients with > 1 BAA were significantly more likely to be female than male (χ test, P = 0.034).

Conclusion: Transcatheter coil embolization combined with stent placement could be a reasonable treatment option for BAAs with a tortuous and short neck. According to our literature review, patients with multiple BAAs display distinctive clinical characteristics compared with patients with a single BAA.

Figure 1

Three-dimensional reconstruction of contrast-enhanced computed tomography scan. The white arrow indicates the bronchial artery aneurysm adjacent to the brachiocephalic trunk. Note the ectopic bronchial artery branching from the brachiocephalic trunk and the extremely short neck of the aneurysm.

Figure 2

Coronary reconstruction of contrast-enhanced computed tomography scan. The 2 small white arrows from left to right show the other bronchial aneurysm and phrenic artery aneurysm, respectively.

Figure 3

Images of aneurysm. (A) Aortic arch aortography in a frontal view. This angiogram shows an aneurysm adjacent to the brachiocephalic trunk. (B) Selective brachiocephalic arteriogrphy before embolization. The aneurysm was fed by an abnormal bronchial artery branching from the brachiocephalic trunk. (C) Postprocedure angiogram in a frontal view. The ectopic bronchial aneurysm had been successfully embolized by interlocking coils. The right common carotid artery and subclavian artery were patent.

Figure 4

Three-dimensional reconstruction of contrast-enhanced computed tomography scan 1 week after operation. The aneurysm was successfully embolized by interlocking coils. The brachiocephalic trunk was patent and protected by a bare metal stent.

Figure 5

Coronary reconstruction of contrast-enhanced computed tomography scan 4 months after operation. The brachiocephalic trunk and right subclavian artery were patent and the aneurysm remained thrombosed.

Figure 6

Common associated diseases of bronchial artery aneurysm. COPD = chronic obstructive pulmonary disease, No = no associated disease identified.