Particle embolization for hemoptysis in two patients with cyanotic congenital heart disease

Abstract Hemoptysis is a known manifestation of complex cyanotic congenital heart disease (CCHD) often related to bleeding from systemic to pulmonary collateral vessels, commonly referred to as aortopulmonary collaterals (APCs). While catheter-directed particle embolization has been historically utilized to treat arterial bleeds causing hemoptysis in other scenarios, coil and vascular plug embolization has been used more frequently to occlude parent arteries in CCHD patients given the concern for shunting of embolic particles. Recently, some centers have shifted to distal particle embolization in treating APCs given its advantages over proximal embolization, including ease of re-treatment if hemoptysis recurs. We describe our experience with distal particle embolization in two CCHD patients experiencing recurrent hemoptysis from APCs following proximal device embolization, highlighting the challenges in endovascular management of these patients.