Bronchial Artery Embolization in Lucknow

Coughing up blood, called haemoptysis, always needs medical attention. If you are bringing up more than streaks of blood, if it keeps happening, or if you feel breathless, dizzy or faint, go to the nearest hospital emergency department now. Do not wait for a scan or a clinic appointment.

While you get help, sit upright rather than lying flat. Do not travel alone: ask someone to take you, or call an ambulance. Take your earlier reports and medicines if they are at hand, but do not delay leaving to find them.

Even a small amount of blood, or blood-streaked phlegm, should be seen by a doctor soon, ideally the same day. A small bleed can be the first sign of a larger one, and the cause needs to be found.

Bronchial artery embolization (BAE) blocks the artery that is feeding a bleeding area in the lung or airways. In serious coughing of blood, the bleeding most often comes from the bronchial arteries, which are small vessels that supply the walls of the airways. When the lung is diseased, these arteries can enlarge and bleed.

A thin catheter is passed into an artery, usually at the groin. Under live imaging, the radiologist injects dye to find the abnormal arteries, then releases tiny particles into them to block the flow. Sometimes other arteries that supply the chest wall also need treatment.

The aim is to control the bleeding. BAE does not treat what caused it, so the bleeding can return.

Common causes include tuberculosis and the scarring it leaves, long-standing airway damage called bronchiectasis, chest infections, a fungal ball in an old lung cavity, and lung tumours. Sometimes no cause is found.

A chest X-ray is the usual first test. It can show infection, scarring, a cavity or a mass. A CT scan of the chest, often with dye, shows the lung changes in detail and maps the arteries before embolization. We do not do CT or MRI scanning at the centre. The treating doctor advises where to get one, and we can review the images and reports.

Blood tests, a sputum test and sometimes a bronchoscopy, where a thin camera looks into the airways, are also used. A biopsy may be needed if a mass is seen. Some people with lung disease also have fluid around the lung, and a pleural tap to drain it is a separate procedure.

BAE is considered when the bleeding is heavy or keeps coming back, and the bleeding artery can be found on imaging. It may be done as an emergency, or in a planned way for someone who coughs up blood repeatedly.

Other options include treating the cause with antibiotics or anti-tuberculosis medicines, medicines that reduce bleeding, treatment through a bronchoscope, and surgery to remove the diseased part of the lung. Which is right depends on how much blood has been lost, the cause, the condition of the lungs and how fit a person is for surgery.

BAE may be less suitable if the artery cannot be reached safely, or if the bleeding does not come from a bronchial artery. The specialist team decides this from the imaging.

Emergency bleeding is dealt with at the nearest hospital with emergency and chest services. If your doctor has planned BAE for repeated bleeding, you can send the referral, imaging and reports to our team. The team reviews them first, then confirms whether the procedure is carried out at the centre or elsewhere, and by whom.

The bleeding can come back, because the lung disease is still there. A person may need a repeat embolization, treatment of the cause, or surgery. These are the other risks, in general terms:

• Chest pain and difficulty swallowing: for a few days after the procedure, which usually settles.
• Fever: a low fever can follow, as with other embolization procedures.
• Spinal cord injury: rarely, a small artery that supplies the spinal cord arises from the same place as a bronchial artery. If particles reach it, weakness or numbness of the legs can follow. Careful mapping of the arteries aims to avoid this.
• Treatment reaching the wrong place: particles can rarely reach another organ, such as the gullet.
• Dye and puncture site: an allergic reaction, kidney strain, bruising or an injured artery at the groin.

Your own risks depend on the lungs, the cause and your general health. The team explains them before asking for consent. In an emergency, the treating team weighs them against the danger of continuing bleeding.