Pulmonary hemorrhages (hemoptysis) originating from the lungs can sometimes reach life‐threatening proportions and may require emergency intervention. These hemorrhages can arise due to various disorders in the lungs or may sometimes be the result of long-standing chronic diseases. It is at this point that a treatment method called “bronchial artery embolization” comes into play. This method controls bleeding by occluding the responsible vessels.
| Definition | – It is a minimally invasive procedure applied to stop severe hemorrhages (hemoptysis) originating from the bronchial arteries. The artery is occluded using embolization materials. |
| Indications | – Severe or recurrent hemoptysis (coughing up blood) – Bronchiectasis – Lung infections (e.g., tuberculosis, aspergillosis) – Lung cancer – Pulmonary artery fistulas – Idiopathic (unknown cause) hemoptysis |
| Procedure | – Under local anesthesia, a catheter is usually inserted through the groin. – The catheter is advanced into the bronchial arteries under fluoroscopic guidance. – The target arteries are visualized using a contrast agent. – The bleeding artery is occluded with embolization agents (e.g., microparticles, adhesives, coils). |
| Advantages | – It is a minimally invasive method. – Does not require general anesthesia. – Provides rapid recovery. – Effectively controls acute bleeding. |
| Risks and Complications | – Chest pain – Fever (temporary post-embolization syndrome) – Bronchial ischemia or necrosis (rare) – Non-target embolization of healthy vessels – Rarely, paraplegia (involvement of the spinal cord) |
| Success Rate | – Generally achieves a success rate of 85-90% on the first application. – A second embolization may be required in cases of recurrent hemoptysis. |
| Preparation | – The patient may discontinue blood thinners under medical supervision before the procedure. – Fasting may be required prior to the procedure. – The medical history, medications, and allergies must be shared with the doctor. |
| Procedure Duration | – It generally lasts between 0.5-1 hour. |
| Recovery Process | – After the procedure, the patient is usually observed for a few hours. – Normal activities can typically be resumed within a few days. |
Prof. Dr. Özgür KILIÇKESMEZ
Interventional Radiology / Interventional Neuroradiology
What Is Bronchial Artery Embolization (BAE)?
Bronchial artery embolization (BAE) is a treatment method belonging to the field of interventional radiology, used to stop bleeding originating from the lungs (hemoptysis). In simple terms, it can be described as controlling the hemorrhage by occluding the bleeding vessels in the lungs with special materials.
Why “bronchial” arteries?
Our lungs are supplied not only by “pulmonary” vessels but also by vessels called “bronchial” arteries, which branch directly from the main artery (aorta). The vessels that often cause serious hemorrhages are these bronchial arteries. Therefore, to stop the bleeding, it is necessary to directly disable these vessels.
What is embolization?
Embolization means occluding a bleeding vessel with materials that act as a “plug” to stop the blood flow. These plugs can be, for example, small particles, adhesives, or even tiny metallic spirals (coils).
BAE can be likened to turning off the taps to stop the water entering a house. If there is a leaking tap in one room, water will continue to flow through the pipe, causing damage to the room. The way to reduce the damage inside the room is to reach the tap and cut off the water flow. Similarly, bronchial artery embolization stops the blood flow by reaching the “leaking” vessels.
BAE is mostly preferred for controlling severe or frequently recurring lung hemorrhages. Due to its rapid intervention and high success rate, it plays a “life-saving” role in many patients.
In Which Situations Is Bronchial Artery Embolization Recommended?
Sometimes people may be alarmed by a few drops of blood when coughing. However, BAE is generally performed in cases of large amounts of bleeding (for example, more than 200-300 mL in 24 hours) or recurrent lung hemorrhages. Of course, physicians also consider the underlying causes when evaluating each patient.
Life-Threatening Hemoptysis (Massive Bleeding)
Also known as massive hemoptysis, this condition involves a high volume of bleeding in a short period. The patient may have difficulty breathing or even face the risk of asphyxiation. In such cases, time is of the essence. Bronchial artery embolization is effective in rapidly controlling the bleeding.
Recurrent Bleeding
If significant amounts of blood are coughed up several times a week, it can severely affect the patient’s quality of life. Moreover, as the underlying disease progresses, the severity of the bleeding may increase. BAE can largely stop these recurrent hemorrhages.
Chronic Hemoptysis
Some patients may experience low to moderate intensity bleeding that gradually increases or persists over a long period. If the bleeding cannot be stopped by medical treatment, BAE offers a solution.
Diseases Such as Bronchiectasis, Tuberculosis, Aspergillosis
Bronchiectasis: In this chronic disease characterized by the continuous widening and inflammation of the bronchi, bleeding is a common complaint.
Patients who have had or are still being treated for tuberculosis: Bleeding may occur due to tissue destruction and vascular abnormalities.
Aspergillosis: This fungal infection can create cavities in the lungs and cause vascular destruction.
In such conditions, the abnormal vessels causing the bleeding can be occluded with BAE.
Bleeding Associated with Lung Cancer
Bleeding due to cancer may sometimes be too complex to be stopped solely by surgical intervention. Sometimes the patient may not be suitable for surgery. In such cases, BAE is used as a palliative (supportive) measure or sometimes as an adjunct to definitive treatment.
In short, bronchial artery embolization stands out as an effective option for stopping lung hemorrhages that are either acutely life-threatening or chronically debilitating.
How Is Bronchial Artery Embolization Performed?
As the name implies, this procedure is performed by interventional radiology specialists using a special imaging technique called angiography. The procedure generally follows the steps outlined below:
Preparation Phase
Imaging: The first step is a detailed examination of the lungs and vascular structures. For this purpose, a computed tomography (CT) scan is often performed. This examination provides information about the source of the bleeding.
General Health Checks: The patient’s blood values, clotting factors, and other systemic conditions (such as cardiovascular health) are evaluated.
Informed Consent: The procedure, its possible risks, and benefits are explained to the patient. Written consent is obtained.
Vascular Intervention
Angiography Suite: The procedure is performed in an area equipped with a special X-ray device where imaging and the intervention are carried out together.
Catheter Advancement: A thin and flexible tube (catheter) is inserted through a peripheral artery, usually from the groin (femoral) or the wrist (radial), and advanced to the aorta (the largest artery in the body).
Selective Catheterization: At this stage, the catheter is directed up to the orifice of the bronchial arteries in the target region. It is similar to navigating a maze to reach a target door: specially curved catheters are used to find the correct path.
Angiographic Evaluation
Administration of Contrast Agent: When a special contrast dye is injected, the vascular structure becomes visible on the screen. This enables the identification of the bleeding focus or vascular anomalies (dilatations, leakages, tumor-related abnormalities, etc.).
Focusing on the Bleeding Vessel: If angiographic images reveal “tortuosity” (curved structure), “hypervascularity” (excessive vascularity), “extravasation” (leakage outside the vessel), or an “aneurysm” (ballooning), the physician targets that area.
Embolization (Occlusion) Procedure
Use of a Microcatheter: A finer catheter (microcatheter) is used to reach the bleeding vessel with millimetric precision.
Application of Embolic Agents: Different materials may be used to occlude the bleeding vessel:
- PVA (Polyvinyl Alcohol) Particles: Small, sponge-like particles that physically obstruct blood flow.
- Gelatin Sponge: Acts as a temporary plug; the body gradually absorbs this material.
- N-Butyl-2-Cyanoacrylate (NBCA): An adhesive that rapidly hardens upon contact with blood.
- Metal Coils: Tiny spiral wires inserted into the vessel that trigger blood clot formation to stop the bleeding.
Administration of the Embolic Material: Under simultaneous X-ray control, the correct region is identified, and the embolic agent is delivered. This effectively plugs the inside of the vessel.
Completion of the Procedure
Control Angiography: After the occlusion, contrast dye is injected again to verify that the bleeding has stopped.
Removal of the Catheter: Once the procedure is complete, the catheter is withdrawn and the entry site (groin or wrist) is compressed for a short period to prevent bleeding.
Observation: The patient is usually observed for 24 hours. During this period, symptoms such as fever and pain are closely monitored.
Each of these steps is performed with great precision, as the goal is not only to stop the bleeding but also to avoid damaging the vital vessels that supply blood to other parts of the body.
What Is the Recovery Process After BAE?
The BAE procedure is generally considered safe and offers a much shorter recovery period compared to open surgery. However, as with any medical intervention, it is useful for patients to be aware of some important points:
Early Period (First 24-48 Hours)
Hospital Observation: The patient is monitored to check for any recurrence of bleeding or an increase in pain or fever.
Pain Management: Chest or back pain may occur, especially immediately after the procedure. This pain is usually mild to moderate and can be easily controlled with analgesics.
Fever and Fatigue: The body may develop a mild fever and fatigue as a response to the procedure and the local irritation in the vessels. This is typically a transient condition.
Intermediate Period (First 1-2 Weeks)
Resumption of Daily Activities: Most individuals begin to return to their normal activities within a few days. However, strenuous activities such as heavy lifting or intense exercise should be avoided.
Follow-Up: The doctor typically schedules a follow-up appointment after one week or 10 days. Repeat lung imaging may be performed if necessary.
Long Term
Recurrence of Hemoptysis: Although BAE occludes the abnormal vessels, if the underlying disease persists, bleeding may recur months or even years later. Recurrence rates vary between 10% and 50%. Therefore, regular medical follow-ups and necessary medication should not be neglected.
Quality of Life: For patients with frequent bleeding episodes, BAE significantly reduces anxiety and physical discomfort. Patients experience the comfort of better breathing and living without the fear of bleeding.
Doctor Appointments and Treatment Plan
Treatment of the Underlying Disease: For example, if the condition is related to bronchiectasis or tuberculosis, collaboration with specialists (such as pulmonologists or infectious disease experts) is maintained.
Preventive Recommendations: If the patient smokes, cessation is recommended, along with regular exercise and a healthy diet.
Surgical Options: In cases where the bleeding is due to a tumor or an operable lesion, surgical treatment may become necessary in the long term. BAE can be used both before and after surgery in these patients.
What Are the Possible Risks of Bronchial Artery Embolization?
Although BAE is a highly successful method in preventing serious hemorrhages, like any medical procedure, it carries some risks and side effects. Fortunately, most of these are rare or mild.
Temporary Chest or Back Pain
This is a common occurrence after the procedure and usually subsides within a few days. It can be controlled with pain relievers.
Fever and Fatigue (Post-Embolization Syndrome)
The body may react to the embolic material and minor tissue damage with fever and weakness. This condition often resolves within a few days.
Difficulty Swallowing (Dysphagia)
Some patients may experience a temporary sensation of something being stuck in the throat or difficulty swallowing. This is usually due to partial involvement of the branches leading to the esophagus and is generally not permanent.
Non-Target Embolization
Involvement of Spinal Arteries: One of the most feared yet very rare complications. In cases where the bronchial arteries are connected to spinal vessels, inadvertent embolic material entry into these vessels can lead to paralysis. A thorough angiographic evaluation and “super-selective” catheterization minimize this risk.
Involvement of Coronary Arteries: Although extremely rare, if there is a connection (fistula) between the lung vessels and the coronary arteries supplying the heart, embolic material may accidentally enter the heart’s blood vessels. Such anatomical variations are carefully evaluated.
Risk of Recurrent Bleeding
Underlying Disease Factor: Particularly in chronic infections or progressive tumor conditions, new abnormal vessels may form over time, potentially leading to recurrent bleeding.
Vascular Recanalization: Occasionally, embolized vessels may reopen. Although this is uncommon, if it occurs, a second embolization or alternative treatment may be necessary.
These risks are minimized thanks to advanced technology and experienced specialists. The thorough preparations before the procedure and the meticulous approach during the procedure are aimed at preventing these rare complications.
How Does This Method Compare to Other Treatment Options?
When compared with other options such as surgery or medication, BAE stands out for several advantages:
- Less Invasive: Unlike major surgery, there are no large incisions made in the body. Apart from the small puncture for the catheter, there is no scar. The recovery time is short.
- Rapid Results: In emergency situations like massive hemoptysis, BAE typically stops the bleeding quickly, significantly reducing the life-threatening risk.
- Fewer Side Effects: Risks such as those associated with general anesthesia, blood loss, and infection are much lower than in major surgical procedures.
- An Alternative or Bridge to Surgery: Some patients may not be suitable for lung surgery (due to advanced age, comorbidities). In these individuals, BAE can serve as a definitive treatment or be used to control bleeding before surgery.
Of course, depending on the type of underlying disease, surgical intervention may sometimes be unavoidable. However, today many physicians prefer to first relieve the emergency with BAE in cases of massive bleeding, followed by other treatments if necessary.
Bronchial artery embolization (BAE) is an effective and safe method for stopping lung hemorrhages that reach dangerous levels or significantly reduce a patient’s quality of life. It provides great benefits in both emergency and chronic situations.
When a person is considered a candidate for this procedure or is referred for it, a detailed evaluation is first carried out by specialist physicians. Then, the pros and cons, risks, expected recovery process, and alternative treatments are discussed with the patient so that an informed decision can be made.
Today, thanks to advances in technology, the diversification of embolic materials, and the increased experience of physicians, BAE has become much safer and more successful. Especially by avoiding critical vessels that supply the heart, brain, and spinal cord and targeting only the bleeding area, the success of the method is significantly enhanced. For this reason, in the fight against lung hemorrhages, bronchial artery embolization is considered one of the most powerful tools offered by modern medicine.
BAE’s Prices 2025[/h2]
Prices may vary depending on the hospital’s facilities, the level of expertise of the doctor, the type of embolic materials used, and the patient’s additional health problems. Specific information can be obtained based on the hospital and insurance coverage.Frequently Asked Questions
Is Bronchial Artery Embolization (BAE) a painful procedure?
Since it is generally performed under local anesthesia or sedation, intense pain is not felt during the procedure. Some patients may describe a slight discomfort or a sensation of pressure; however, most find the process tolerable.
How long does the procedure take?
The duration of the procedure varies according to the complexity of the vascular anatomy. In some cases, it may be as short as half an hour, while in others it can take up to an hour. Discharge on the same day is possible along with the observation period.
What is the main difference between BAE and lung surgery?
BAE is performed by inserting a catheter into the femoral or radial artery without making a large surgical incision. In this respect, it is less invasive than surgery, with a generally shorter hospital stay and faster recovery.
How long do I need to stay in the hospital after BAE?
Most patients are observed for about 6 hours after the procedure. If there is no recurrence of bleeding or other complications, discharge is possible the next day. In some cases, the doctor may request additional observation.
Does smoking affect the success of BAE?
Since smoking adversely affects lung tissue, it may increase the risk of bleeding and lung damage. Quitting smoking after the BAE procedure is important for maintaining lung health.
Is general anesthesia required during BAE?
In most cases, local anesthesia and, if necessary, light sedation are preferred instead of general anesthesia. This allows the patient to remain partially conscious while minimizing pain and discomfort.
Can I undergo BAE if I have a high fever?
A fever may indicate an underlying infection or inflammatory condition. Doctors will first evaluate the cause of the fever. Once the necessary treatments or tests have been completed, they will decide whether BAE is appropriate.
How long should I avoid heavy work or sports after BAE?
It is recommended to rest for a few days following the procedure. Avoiding heavy lifting, intense exercise, or strenuous sports activities is generally advised for 1-2 weeks. The exact duration depends on the doctor’s personalized recommendations.
Do I need to change my diet after BAE?
Even if there are no specific dietary restrictions, maintaining a balanced and healthy diet is beneficial for lung health and overall recovery. Drinking plenty of fluids and avoiding harmful habits like smoking is also important.
Can this procedure be repeated?
BAE can be repeated when necessary. Especially if the underlying disease persists or if new abnormal vessels develop, the same procedure may be considered again in the future.
Is BAE applicable in children?
Although rare, serious lung hemorrhages can occur in children as well. In pediatric patients, BAE may be used when necessary. The suitability is determined based on the child’s overall health and the source of the problem.
Is there a risk of shortness of breath after BAE?
Although there may be temporary discomfort or mild breathing difficulties immediately after the procedure, it generally does not lead to long-term shortness of breath. This may vary depending on the course of the underlying disease.
How is the cost of BAE determined?
Prices may vary depending on the hospital’s facilities, the level of expertise of the doctor, the type of embolic materials used, and the patient’s additional health issues. Specific information can be obtained based on the hospital and insurance coverage.
When can I return to my daily routine after the procedure?
Most patients are able to return to their daily routines after a few days of rest. Postponing or reducing intense physical activities supports recovery.
Is BAE applicable during pregnancy?
As with any medical procedure during pregnancy, a benefit-risk assessment is important. In cases of serious bleeding where the life of the mother is at risk, BAE may be necessary; however, the decision is made through the consensus of the relevant specialists.
Is exposure to radiation during the procedure harmful?
A low dose of radiation is used during angiography. Expert teams take measures to minimize both the duration and dose of radiation. The potential harm to the patient is considered very low compared to the benefits of the treatment.
Which doctor should I consult to have a BAE procedure?
This procedure is performed by interventional radiologists. It is generally carried out in collaboration with pulmonologists or thoracic surgeons.
Do I need to continue medication after the BAE procedure?
If there are antibiotics or other medications related to the underlying disease, they should be continued as per the doctor’s recommendation. Additionally, pain relievers or supportive medications may also be prescribed.
Does the occlusion of the vessel during BAE cause problems for other organs?
The procedure is aimed solely at targeting the vessel responsible for the bleeding. An experienced team minimizes the risk of affecting adjacent or connected vessels. Therefore, the likelihood of adverse effects on other organs is low.
Does BAE provide a permanent solution?
For many patients, long-term or permanent relief is achieved; however, the certainty depends on the type and course of the disease. If the underlying condition cannot be controlled or new lesions develop, repeat BAE may be necessary.
Prof. Dr. Özgür Kılıçkesmez graduated from Cerrahpaşa Medical Faculty in 1997. He completed his specialization at Istanbul Education and Research Hospital. He received training in interventional radiology and oncology in London. He founded the interventional radiology department at Istanbul Çam and Sakura City Hospital and became a professor in 2020. He holds many international awards and certificates, has over 150 scientific publications, and has been cited more than 1500 times. He is currently working at Medicana Ataköy Hospital.
Since it is generally performed under local anesthesia or sedation, intense pain is not felt during the procedure. Some patients may describe a slight discomfort or a sensation of pressure; however, most find the process tolerable.
The duration of the procedure varies according to the complexity of the vascular anatomy. In some cases, it may be as short as half an hour, while in others it can take up to an hour. Discharge on the same day is possible along with the observation period.
BAE is performed by inserting a catheter into the femoral or radial artery without making a large surgical incision. In this respect, it is less invasive than surgery, with a generally shorter hospital stay and faster recovery.
Most patients are observed for about 6 hours after the procedure. If there is no recurrence of bleeding or other complications, discharge is possible the next day. In some cases, the doctor may request additional observation.
Since smoking adversely affects lung tissue, it may increase the risk of bleeding and lung damage. Quitting smoking after the BAE procedure is important for maintaining lung health.
In most cases, local anesthesia and, if necessary, light sedation are preferred instead of general anesthesia. This allows the patient to remain partially conscious while minimizing pain and discomfort.
A fever may indicate an underlying infection or inflammatory condition. Doctors will first evaluate the cause of the fever. Once the necessary treatments or tests have been completed, they will decide whether BAE is appropriate.
It is recommended to rest for a few days following the procedure. Avoiding heavy lifting, intense exercise, or strenuous sports activities is generally advised for 1-2 weeks. The exact duration depends on the doctor’s personalized recommendations.
Even if there are no specific dietary restrictions, maintaining a balanced and healthy diet is beneficial for lung health and overall recovery. Drinking plenty of fluids and avoiding harmful habits like smoking is also important.
BAE can be repeated when necessary. Especially if the underlying disease persists or if new abnormal vessels develop, the same procedure may be considered again in the future.
Although rare, serious lung hemorrhages can occur in children as well. In pediatric patients, BAE may be used when necessary. The suitability is determined based on the child’s overall health and the source of the problem.
Although there may be temporary discomfort or mild breathing difficulties immediately after the procedure, it generally does not lead to long-term shortness of breath. This may vary depending on the course of the underlying disease.
Prices may vary depending on the hospital’s facilities, the level of expertise of the doctor, the type of embolic materials used, and the patient’s additional health issues. Specific information can be obtained based on the hospital and insurance coverage.
Most patients are able to return to their daily routines after a few days of rest. Postponing or reducing intense physical activities supports recovery.
As with any medical procedure during pregnancy, a benefit-risk assessment is important. In cases of serious bleeding where the life of the mother is at risk, BAE may be necessary; however, the decision is made through the consensus of the relevant specialists.
A low dose of radiation is used during angiography. Expert teams take measures to minimize both the duration and dose of radiation. The potential harm to the patient is considered very low compared to the benefits of the treatment.
This procedure is performed by interventional radiologists. It is generally carried out in collaboration with pulmonologists or thoracic surgeons.
If there are antibiotics or other medications related to the underlying disease, they should be continued as per the doctor’s recommendation. Additionally, pain relievers or supportive medications may also be prescribed.
The procedure is aimed solely at targeting the vessel responsible for the bleeding. An experienced team minimizes the risk of affecting adjacent or connected vessels. Therefore, the likelihood of adverse effects on other organs is low.
For many patients, long-term or permanent relief is achieved; however, the certainty depends on the type and course of the disease. If the underlying condition cannot be controlled or new lesions develop, repeat BAE may be necessary.
Prof. Dr. Özgür Kılıçkesmez graduated from Cerrahpaşa Medical Faculty in 1997. He completed his specialization at Istanbul Education and Research Hospital. He received training in interventional radiology and oncology in London. He founded the interventional radiology department at Istanbul Çam and Sakura City Hospital and became a professor in 2020. He holds many international awards and certificates, has over 150 scientific publications, and has been cited more than 1500 times. He is currently working at Medicana Ataköy Hospital.
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