When the bleeding is massive, bronchoscopy is not useful and angiographic treatment is required. During the procedure, endobronchial balloon occlusion is effective to avoid aspiration of blood into the contralateral lung. Because bronchial arteries and nonbronchial systemic arteries are main sources of hemoptysis, transcatheter embolization of these arteries is widely accepted as a reliable nonsurgical treatment in these serious conditions. Transcatheter embolization of bronchial and nonbronchial systemic arteries is useful not only in immediate hemostasis but also long-term control. But active tuberculosis and aspergillosis are difficult to control by embolization alone.
Effective chemotherapy is essential to achieve good results.
The embolization of these arteries carries the risk of spinal cord injury, but current co-axial catheter systems allow superselective embolization beyond the origin of the anterior spinal artery. The following topics will be discussed. Anatomical considerations of bronchial circulation with emphasis on its relationship to the pulmonary circulation. Vascular anatomy of systemic thoracic arteries and the importance of embolization of nonbronchial systemic arteries. Intracavitary injection of drugs for hemoptysis due to aspergillosis alternative way of treatment.