Endovascular management of tuberculosis-related hemoptysis after thoracic endovascular aortic repair: anatomical characterization and embolization strategy

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Abstract Background This study characterized the anatomical features of aberrant bronchial artery supply in patients with tuberculosis-related hemoptysis after thoracic endovascular aortic repair (TEVAR). It analyzed the technical challenges and strategies of bronchial artery embolization (BAE). The safety and efficacy of adapted embolization strategies were further evaluated. The findings will inform future management of this complex clinical condition. Methods This study analyzed the data of patients diagnosed with tuberculosis-related hemoptysis after TEVAR who underwent BAE between January 2021 and September 2024. We characterized the anatomical features of aberrantly supplied bronchial arteries, applied embolization strategies appropriate to each case. Results All six patients (mean age 67.3 ± 17.9 years) exhibited aberrant bronchial arterial supply, with 66.7% (4/6) demonstrating multivessel collateral networks originating from the internal thoracic, esophageal, and inferior phrenic arteries. The characteristic vascular anatomy of tuberculosis-related hemoptysis following TEVAR is summarized. Initial transfemoral access was unsuccessful in four cases; however, all were successfully rescued via the transradial approach. Catheterization time through the transradial route was significantly shorter than that via transfemoral access (3–15 vs. 28–45 min). The median dose–area product was 140.85 Gy·cm², and the median total fluoroscopy time was 44.4 min, both positively correlated with anatomical complexity. Technical success and immediate hemostasis were achieved in all patients (100%), with no major complications or recurrence of hemoptysis during follow-up. Conclusion Aberrant bronchial arteries in tuberculosis-related hemoptysis after TEVAR demonstrate complex anatomical characteristics. BAE could be performed safely and effectively with preprocedural planning, individualized access selection, and refined superselective techniques. Overall, BAE offers a feasible therapeutic pathway for this challenging condition. Clinical trial registration Clinical trial number: not applicable.

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