Failure of Bronchial Artery Aneurysm Embolization and Use of Thoracic Endoprosthesis

To Editor,

Kano et al ¹ reported, in their recent and interesting article, their single successful case of treatment of bronchial artery aneurysms (BAA) associated with racemose hemangioma by combined therapy of transcatheter bronchial artery embolization and thoracic endovascular aortic repair and conclude that this combined therapy is a safe and effective treatment for BAA.

We agree with the statement that it is recommended that BAA should be treated once it is diagnosed, regardless of the presence or absence of symptoms, because of their high risk of rupture and mortality / morbidity. Furthermore, in relation to the numerous complications related to open surgery the endovascular approach has become the first-line treatment and the embolization represents the method of choice. However, it is not always feasible. ^{2 -4}

In our experience three factors influence the choice to associate the use of a descending thoracic aorta stentgraft: 1) the size of the bronchial aneurysm (> 20 mm); the inability to cannulate the BAA directly; and the failure of a previous embolization (with metallic coils, gelatin particles, fibrin sealant, n-butyl-2-cyanoacrylate, and polyvinyl alcohol). ^{5 -7}

Therefore, we agree that the treatment of choice remains embolization and that the use of a thoracic endoprosthesis (with or without associated embolization) is to be reserved only for selected cases.