BackTable Vascular & Interventional Ep. 586 Bronchial Artery Embolization: Techniques, Outcomes & Complications to Avoid with Dr. Alex Lam
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Nov 4, 2025 Dr. Alex Lam, an assistant professor at UCSF specializing in interventional radiology, dives into bronchial artery embolization techniques and outcomes. He highlights the key factors for successful procedures, including patient evaluation and understanding causes of bronchial artery hypertrophy like tuberculosis and malignancy. Dr. Lam shares tips on catheter selection, the advantages of using glue over traditional particles, and how to manage complications effectively. With a success rate of over 90%, he emphasizes the importance of teamwork and detailed pre-procedure preparations.
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Non-Bronchial Feeders Are Common
- Up to ~20–30% of pulmonary systemic feeders can arise from non-bronchial sources like intercostals or internal mammaries.
- Searching beyond classic bronchial origins prevents missed bleeding sources.
Explicitly Discuss Risks During Consent
- Discuss risks thoroughly, especially neurologic risks like stroke, during consent before the procedure.
- Explain that definitions of massive hemoptysis vary and clinical deterioration—not volume—drives the decision to embolize.
Do A Flush Aortogram First
- Perform a flush aortogram (ascending aorta, straight AP) to map bronchial and non-bronchial systemic feeders before probing vessels.
- Use 15 mL/sec for 30 mL to include subclavians and internal mammaries on the run.