Bronchial Artery-Pulmonary Artery Fistula With Dual Arterial Feeders Treated Successfully With Staged Embolisation Procedures-A Case Report.

Bronchial artery-pulmonary artery fistula (BPAF) is an uncommon vascular malformation with a left-to-right shunt. We report a case of a 72-year-old woman diagnosed with BPAF with two arterial feeders who had no underlying lung diseases and presented with intermittent haemoptysis. Her digital subtraction angiography confirmed BPAF supplied by the right bronchial artery (BA) from the intercostobronchial trunk and another ectopic accessory right BA originating from the right subclavian artery. Considering the future risk of catastrophic rupture due to high systemic pressure exerted on the fistula, prophylactic embolisation procedures via a percutaneous approach were performed. The pulmonary artery was first embolised for outflow control, followed by coil and microvascular plug embolisation on the right BA. The ectopic accessory right BA was later embolised with coil and microvascular plug as a staged procedure. A 14-month post-procedure computed tomography scan confirmed complete thrombosis of both BAs. Our case highlights the efficacy and safety of endovascular embolisation in BPAF.