Successful embolization of a primary bronchial artery racemose hemangioma by the ingenious use of a microballoon catheter.

Primary racemose hemangioma of the bronchial artery (RHBA) is a rare congenital condition characterized by enlarged and convoluted bronchial arteries, often forming fistulas between the pulmonary artery or vein. Herein, we report a case of balloon-assisted embolization using N-butyl-2-cyanoacrylate (NBCA) performed for a primary RHBA in an asymptomatic 57-year-old woman. There were 2 tortuous and dilated branches of the right bronchial artery (RBA) (arising from the left subclavian artery and the descending thoracic aorta) which merged in the right pulmonary hilar region, forming multiple aneurysms that short-circuited the right pulmonary artery. Embolization was performed via the RBA arising from the subclavian artery using a triaxial system (a 5-Fr guiding catheter, a 2.7-Fr microballoon catheter, and a 1.9-Fr microcatheter). The guiding catheter was inserted into the peripheral side of the RBA using the microballoon catheter as an anchor; the balloon was slightly inflated and advanced further into the peripheral side using blood flow. The microcatheter was inserted as close to the aneurysms as possible and embolization was done using an NBCA-iodized oil mixture under blood flow control by the microballoon catheter. Bronchial artery embolization is the treatment of choice for primary RHBA because of the risk of rupture, and balloon-assisted techniques can help guide the catheter distally while also controlling blood flow.

Management of Rare Hemorrhage From Collateral Vessels During Gastrostomy Replacement Using Percutaneous Transhepatic Occlusion in Patient With Portal Hypertension.

A 51-year-old male patient with alcoholic cirrhosis visited our hospital for a scheduled gastrostomy replacement. During the gastrostomy replacement, he suddenly experienced a massive hemorrhage from the fistula site. Based on enhanced computed tomography findings, we concluded that collateral blood vessels from the left gastroepiploic vein had flowed into the varices near the gastrostomy as the main origin of the bleeding. The patient received treatment with percutaneous transhepatic occlusion for the varices, which halted blood flow to the varices. This case suggests the possibility of such a complication in patients with worsening portal hypertension and the effectiveness of percutaneous transhepatic occlusion treatment.