The bronchial arteries are the systemic blood supply to the bronchi, lung parenchyma, visceral pleura, and mediastinal structures. Their number and origin are highly variable: typically two left bronchial arteries arise directly from the descending thoracic aorta, and one right bronchial artery arises from the third intercostal artery or directly from the aorta. They travel alongside the bronchi, branching with each bronchopulmonary segment.
The bronchial arteries are the source of haemoptysis in the vast majority of cases (90%), whether from tuberculosis, bronchiectasis, aspergilloma, or lung cancer. Bronchial artery embolisation (BAE) via femoral artery access is the first-line treatment for massive haemoptysis, with success rates exceeding 80% in the acute setting. Care must be taken to identify and protect the artery of Adamkiewicz if it shares an origin with the right bronchial artery, as inadvertent embolisation causes spinal cord ischaemia. Bronchial artery anastomosis in double lung transplantation restores direct systemic perfusion of the donor bronchi.
Life-threatening bleeding from bronchial arteries, most commonly from bronchiectasis, tuberculosis, or fungal infection, requires urgent bronchial artery embolisation via selective catheterisation after CT angiographic mapping, with lung resection reserved for embolisation failures.
Embolisation of a bronchial artery that shares an origin with the artery of Adamkiewicz causes anterior spinal artery syndrome with paraplegia, a rare but catastrophic complication avoided by meticulous angiographic identification of spinal feeders before embolisation.
