Successful transbrachial embolization of an ectopic bronchial artery arising from the concavity of the aortic arch using the Ishikawa catheter

An 81-year-old man with lower extremity arteriosclerosis obliterans presented with massive hemoptysis. Computed tomography revealed an enlarged ectopic right bronchial artery originating from the concavity of aortic arch, prompting the decision to perform bronchial artery embolization (BAE). Due to occlusion of bilateral femoral and left subclavian arteries, transfemoral or left transbrachial access was not feasible; therefore, right transbrachial access was chosen. BAE was successfully completed, and antiplatelet and anticoagulant therapy was subsequently initiated. No recurrence of bleeding was observed at the time of this report, with a follow-up of at least 20 months. This is the first reported case of transbrachial BAE targeting an ectopic bronchial artery arising from the concavity of the aortic arch, achieved by modifying coronary catheterization techniques with the use of the Ishikawa catheter.