Interventional radiology · London
Bronchial artery embolisation (BAE) - London.
A lifesaving, catheter-based treatment for massive or recurrent haemoptysis. A consultant interventional radiologist selectively catheterises the bleeding bronchial artery and blocks it with 300 to 700 micron PVA particles or coils, stopping the bleeding without opening the chest.
What it is
A selective block of the bleeding bronchial artery.
Bronchial artery embolisation is the first-line interventional treatment for life-threatening haemoptysis, and a durable option for recurrent bleeds.
More than 90 percent of significant haemoptysis originates from the bronchial arterial circulation rather than the pulmonary arteries. In chronic lung disease, the bronchial arteries hypertrophy, become tortuous and recruit non-bronchial systemic collaterals from the intercostal, subclavian, internal mammary and inferior phrenic arteries. These abnormal vessels are fragile and bleed into the airway.
BAE addresses the source directly. A consultant interventional radiologist advances a microcatheter through the femoral artery into each culprit vessel and delivers 300 to 700 micron polyvinyl alcohol (PVA) particles, or coils where the anatomy demands it, until flow stops. The anterior spinal artery is meticulously mapped and avoided to prevent spinal cord ischaemia.
Who it is for
Massive or recurrent haemoptysis.
The situations in which our chest physicians and interventional radiologists refer for BAE.
Massive haemoptysis
Above 200 mL of expectorated blood in 24 hours, or any life-threatening bleed causing airway compromise or haemodynamic instability. Same-day emergency BAE.
Bronchiectasis
Recurrent moderate haemoptysis from chronic airway inflammation and hypertrophied bronchial arteries. Elective BAE gives durable relief.
Cystic fibrosis
Haemoptysis complicates advanced CF and BAE is the standard of care, coordinated with the specialist CF centre.
Previous tuberculosis
Post-TB parenchymal scarring and cavitation drive late haemoptysis; BAE controls the bleed while the sequelae are investigated.
Aspergilloma and AVM
Fungal cavity colonisation and pulmonary arteriovenous malformations both bleed heavily. BAE is used as a bridge to surgery or definitive treatment.
Lung malignancy
Tumour-related haemoptysis, including after radiotherapy. BAE gives palliation of bleeding even when oncological options are exhausted.
How the procedure works
From CT map to embolisation, in one day.
A 60 to 120 minute procedure under local anaesthetic and conscious sedation, in an interventional radiology suite.
Step 1
CT angiography and bronchoscopy
A CT pulmonary angiogram maps the bronchial arteries and any non-bronchial systemic supply and identifies the bleeding lobe. Flexible bronchoscopy may confirm the side and segment. Coagulopathy is corrected and blood cross-matched.
Step 2
Femoral access and aortography
Right common femoral artery access under local anaesthetic. A descending thoracic aortogram opacifies the origins of the bronchial arteries and the intercostobronchial trunk.
Step 3
Selective catheterisation
Each culprit bronchial artery is selectively cannulated with a microcatheter. Angiography identifies the anterior spinal artery, which must be preserved to avoid spinal cord ischaemia. Non-bronchial systemic collaterals are also assessed.
Step 4
Embolisation
Polyvinyl alcohol particles sized 300 to 700 microns are injected slowly under fluoroscopic control until near stasis. Coils are used for large or ectatic vessels. A completion angiogram confirms cessation of flow into the abnormal territory.
Step 5
Overnight observation
Groin closure and 4 hours of bed rest. Overnight monitoring on the ward for post-embolisation syndrome and any recurrent bleeding. Most patients are home the next day.
Step 6
Underlying disease follow-up
Chest physician review at 6 weeks to optimise treatment of the underlying bronchiectasis, CF, aspergilloma or malignancy. Repeat imaging if symptoms recur.
Outcomes and risks
What the data show.
Registry figures from high-volume interventional radiology centres. Long-term durability depends on the underlying lung disease.
85-95%
Immediate control of haemoptysis after first BAE.
20-30%
Recurrence at 12 months, higher in aspergilloma and malignancy.
<1%
Spinal cord ischaemia with modern microcatheter technique.
1 night
Typical hospital stay for elective BAE; longer if emergency.
Durability is best in bronchiectasis and cystic fibrosis and less so in aspergilloma and lung malignancy, where new collateral vessels tend to recruit. Repeat BAE is straightforward and equally effective. Other risks are post-embolisation syndrome (chest pain, low-grade fever, dysphagia in up to 30 percent, settles in days), groin bruising and, rarely, non-target embolisation.
Indicative pricing
What private BAE costs in London.
All-inclusive private packages at our partner London interventional radiology centres.
In short
£8,500-£14,000 all-inclusive, home next day.
| Item | Indicative range | Stay |
|---|---|---|
| Respiratory or IR consultation | £300-£500 | Outpatient |
| CT pulmonary angiogram and bronchoscopy | £1,500-£3,000 | Day |
| Bronchial artery embolisation, elective | £8,500-£11,500 | 1 night |
| Bronchial artery embolisation, emergency or complex | £11,000-£14,000 | 2-3 nights |
Prices vary by centre, operator and complexity. Emergency BAE for massive haemoptysis is covered by all major insurers.
Where it is done in London
Our London interventional radiology panel.
BAE should only be done at centres with 24/7 interventional radiology cover and on-site thoracic surgery back-up.
Royal Brompton IR
National respiratory centre with a high-volume BAE service and specialist bronchiectasis, CF and aspergillosis clinics.
HCA London Bridge Hospital
Private interventional radiology suite with on-site thoracic surgery and critical care.
HCA The Wellington
Full interventional radiology and respiratory service including emergency BAE cover.
University College London Hospital Private
Academic IR programme with 24/7 emergency embolisation for haemoptysis.
King’s College Hospital Private
Tertiary IR service with expertise in complex non-bronchial systemic collaterals.
Cromwell Hospital (BUPA)
Central London private IR service with rapid access for elective BAE.
Related
Related interventional and diagnostic pathways.
Frequently asked
Everything patients ask about bronchial artery embolisation.
Quick answers on effectiveness, timing, risks, recovery, repeat procedures and insurance.
How effective is BAE?
Immediate control of haemoptysis is achieved in 85 to 95 percent of patients. Durability depends on the underlying disease: better in bronchiectasis and CF, less durable in aspergilloma and lung cancer, where 20 to 30 percent recur at 12 months and repeat BAE is often needed.
Is BAE done as an emergency or planned?
Both. Massive haemoptysis (above 200 mL in 24 hours) is a same-day emergency. Recurrent moderate haemoptysis is planned as an elective day-case after CT angiography and bronchoscopy.
What are the main risks?
Spinal cord ischaemia from inadvertent anterior spinal artery embolisation is now rare (below 1 percent) with microcatheter technique. Post-embolisation syndrome (chest pain, fever, dysphagia) affects up to 30 percent and settles in days. Groin bruising and non-target embolisation are uncommon.
How long is recovery?
Most patients are discharged the day after the procedure. Groin site care for 48 hours, light activity for a week, then normal activity. Underlying lung disease management continues in parallel.
Might I need a repeat embolisation?
Yes, 20 to 30 percent of patients rebleed within 12 months from new collateral recruitment or disease progression. Repeat BAE is straightforward and equally effective. Surgery is considered if bleeding persists despite two or more embolisations and anatomy allows.
Do UK insurers cover BAE?
Most major UK insurers (Bupa, AXA Health, Vitality, Aviva, WPA, Cigna) cover BAE where clinical criteria are met and pre-authorisation is obtained. Emergency BAE for massive haemoptysis is generally covered without delay.