Bronchial artery embolisation - A guide for patients

Introduction

This leaflet is designed for patients who have been advised to have a bronchial artery embolisation procedure as part of the treatment for recurrent haemoptysis (coughing up blood).

Contents

• What is a bronchial artery embolisation ?
• Why do I need a bronchial artery embolisation?
• Who has made the decision for me to have a bronchial artery embolisation?
• What are the benefits?
• What happens before the procedure?
• Who will be performing the bronchial artery embolisation?
• What happens during the bronchial artery embolisation?
• Will the bronchial artery embolisation hurt?
• How long will the bronchial artery embolisation take?
• What will happen after the bronchial artery embolisation?
• What are the possible risks?
• Radiation
• Conclusion
• Privacy and dignity

What is a bronchial artery embolisation?

• A bronchial artery embolisation is a procedure where abnormal arteries supplying blood to your lungs are blocked.
• Usually arteries do not show up on an ordinary x-ray so a special dye, called contrast medium, is injected into the arteries through a fine plastic tube called a catheter to make them visible.
• X-rays are taken during the procedure. These images will assist the doctors in performing the procedure.

Why do I need a bronchial artery embolisation?

• Patients are advised to consider a bronchial artery embolisation when they are having repeat episodes of haemoptysis (coughing up blood). Scans done to investigate the haemoptysis can show abnormally large arteries suppling blood to the lungs (these are the bronchial arteries).
• Through blocking the arteries the episodes of haemoptysis can be reduced or stopped.
• Blocking the bronchial arteries does not usually affect the lung function, as the lungs have another larger blood supply from a different blood circulation.

Who has made the decision?

• The consultant in charge of your case and the radiologist performing the bronchial artery embolisation will have discussed the situation, and come to the conclusion that this is the best way of treating your condition.
• However, you will also have the opportunity for your opinion to be taken into account, and if, after discussion with your doctors, you do not want the procedure carried out, you can decide against it.

What are the benefits?

• The purpose of the bronchial artery embolisation is to reduce the arterial blood supply to the lungs, in order to lower the frequency and amount of haemoptysis.
• Alternative treatments to treat haemoptysis would usually involve surgical intervention and embolisation has a much lower level of risk.

What happens before the procedure?

• You will be admitted to a hospital ward on the day of, or the night before, the bronchial artery embolisation.
• A doctor will take a history from you.
• You may have a small needle put into a vein in your arm for painkillers to be given if necessary.
• Standard blood tests may be carried out.
• You may eat a light meal.
• You may be given antibiotics on the morning of the procedure.
• If you have any allergies you must let your doctor know.
• If you take any medications to thin the blood (anticoagulants or antiplatelets) please let us know beforehand, as these will need to be stopped a certain length of time before the procedure.
  • Examples include: warfarin, dalteparin, enoxaparin, tinzaparin, dabigatran, rivaroxaban, apixaban, clopidogrel, ticagrelor.
  • Low dose aspirin (75mg) is safe to continue.
  • Please discuss with a doctor before stopping any medicines, as sometimes other treatment will need to be given.
• If you have previously reacted to intravenous contrast medium (the dye used for CT scans), you must also tell your doctor about this.

Who will be performing the bronchial artery embolisation?

• A specially trained doctor called an interventional radiologist will be performing your bronchial artery embolisation.
• Radiologists have special expertise in using x-ray equipment and in interpreting the images produced.
• They will look at these images while carrying out the procedure.
• The radiologist will be assisted by a radiographer and nurses.

What happens during the bronchial artery embolisation?

• You will get dressed into a hospital gown.
• You will lie on the x-ray table, generally flat on your back.
• You will have a monitoring device attached to your finger, and will have a blood pressure cuff placed around your arm.
• The procedure is performed under sterile conditions and the radiologist and scrub nurse will wear sterile theatre gowns and operating gloves.
• Most often an artery in the groin is used, but occasionally an arm or wrist artery will be chosen. Your doctor will tell you beforehand which artery will be used. Your skin will be cleaned and local anaesthetic given to numb the area, and prevent any pain. A small tube is then placed into the artery.
• Small catheters (plastic tubes) will then be guided to the lung arteries using x-ray guidance.
• When pictures need to be taken some iodine dye will be injected; you will be asked to hold your breath for a short time at these points. You may feel a hot sensation from the dye, and it can make your bladder feel full.
• Once the catheter is in the right place, the artery will be blocked. Usually tiny plastic particles are injected to block the artery.
• Sometimes several arteries must be blocked, depending on how complicated the blood supply to the lungs is.
• After the arteries have been blocked you will move back onto the hospital bed. The tube in the artery will then be removed, and pressure applied on the site for several minutes.

Will the bronchial artery embolisation hurt?

• Some discomfort may be felt in the skin and deeper tissues during injection of the local anaesthetic.
• You may feel a warm sensation for a few seconds when the x-ray dye is injected and some people report a metallic taste in the mouth. You may also feel like you are passing urine; this is normal.
• There will be a nurse, or another member of the clinical staff, in the room looking after you.
• If the procedure does become too uncomfortable, please let a member of staff know.
• Following the procedure you may develop chest or upper abdominal discomfort, and / or nausea. If you experience any of these symptoms let the nursing staff know.

How long does the bronchial artery embolisation take?

• Every patient’s situation is different, and it is not always easy to predict how complex or how straightforward the procedure will be.
• Generally, the procedure will last approximately two hours.
• As a guide you will be in the x-ray department for approximately three to four hours before we will send you to a ward for observation.

What will happen after the bronchial artery embolisation?

• You will be taken back to your ward for overnight observation.
• Nursing staff may carry out routine observations including taking your pulse and blood pressure and will also check the treatment site.
• If you experience pain or sickness let the nursing staff know.
• You will need to stay in bed for four to six hours, including a two hour period of lying flat.

What are the risks?

• Bronchial artery embolisation is generally a safe procedure, but as with any procedure there are risks.
• Bruising at the artery puncture site is a relatively common problem. Rarely significant bleeding or artery damage may need to be treated with an operation.
• Most patients will feel tired following the procedure, often with flu-like symptoms. This is known as post embolisation syndrome. These symptoms should settle over 1 to 2 weeks. If you are getting worsening fevers you should contact the respiratory team, or your normal specialist, as it may indicate an infection in the lung.
• Some patients may develop chest pain or have difficulty in swallowing after the procedure for a short period of time.
• There is a small risk of injury to the arteries.
• There is a very small risk of the injected beads moving to locations not intended. Occasionally there are blood vessels to the spinal cord that join to the bronchial arteries. If the embolisation particles were to enter these arteries there is a very small risk of damaging the spinal cord, which may cause paralysis.
• Very rarely the beads may move to other organs, which could be serious depending on which organ is affected.
• Your kidney function may rarely be affected by the contrast dye injected, though this usually recovers.

Radiation

• You have been referred for an Interventional Radiology procedure to help deliver your treatment. A specialist in radiology agrees that this is the best procedure to treat your clinical condition and that the benefit of the examination is greater than the risk.
• The x-ray involves a dose of ionising radiation equivalent to a few months or years of natural background radiation which we are all exposed to every day.
• Ionising radiation can cause cell damage that may turn cancerous however the risk of this happening from your examination is considered low.
• Depending on the length of the procedure there may also be a small risk of an excess radiation dose to the skin leading to short term and long term effects (e.g. reddening of the skin and burns).
• If this happens as a result of this procedure, you will receive further advice following the procedure. The dose delivered will be kept as low as is practicable
• For further information please see the CUH Imaging (Radiology) Service Page

Conclusion

• Some of your questions about your procedure should have been answered by this leaflet, but remember that this is only a starting point for discussion about your treatment with the doctors looking after you.

This document has been adapted from one prepared by the British Society of Interventional Radiology (BSIR).

Privacy and dignity

We are committed to treating all patients with privacy and dignity in a safe, clean and comfortable environment. This means, with a few exceptions, we will care for you in same sex bays in wards with separate sanitary facilities for men and women.

In some areas, due to the nature of the equipment or specialist care involved, we may not be able to care for you in same sex bays. In these cases staff will always do their best to respect your privacy and dignity, for example with the use of curtains or, where possible, moving you next to a patient of the same sex. If you have any concerns, please speak to a member of the radiology team, ward sister or charge nurse.