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Therapeutic approaches for pulmonary artery pseudoaneurysms and analysis of outcomes
Serhat Akis1, Young Ho So2,3,4, Junyoung Lee5
1Department of Radiology, Dokuz Eylul University Medical School Hospital, Izmir, Türkiye.
Objectives:
To evaluate the therapeutic approaches for pulmonary artery pseudoaneurysms (PAPs) with various etiologies and types, and outcomes.
Materials And Methods:
Between March 2010 and March 2024, 30 PAPs were identified in 29 patients. We analyzed the medical records of 29 PAPs in 28 patients whose etiologies were confirmed. Patient characteristics, underlying lung abnormalities, PAPs' characteristics, therapeutic approaches, and outcomes were evaluated.
Results:
Twenty-nine PAPs were treated in 28 patients (mean age 59 years ± 12.4; 25 males). The etiologies of PAPs were pulmonary tuberculosis (n = 22), necrotizing pneumonia (n = 6), and iatrogenic (n = 1). In one tuberculosis patient, two PAPs occurred at different times. Hemoptysis volume varied according to etiology, with no hemoptysis in iatrogenic PAP. In 21 PAPs, pulmonary artery embolization (PAE) (n = 15), embolization via systemic-to-pulmonary shunt or bronchial/non-bronchial systemic artery embolization (BAE/SAE) (n = 5), and medical treatment (n = 1) were performed after pulmonary arteriography. For eight PAPs, embolization via systemic-to-pulmonary shunt or BAE/SAE (n = 7), and medical treatment (n = 1) were performed without additional pulmonary arteriography. Two patients underwent medical treatment because they had small (< 5 mm) or isolated PAP from the pulmonary artery. In 23 patients (24 PAPs), PAPs regressed or hemoptysis ceased. Two patients underwent surgery during follow-up. Three patients died from sepsis or massive hemoptysis. There were no complications related to the procedure.
Conclusion:
PAE is an effective treatment for PAPs, but empirical embolization via systemic-to-pulmonary artery shunt can be an effective alternative treatment for PAPs not detected on pulmonary angiography. In addition, medical treatment can be considered in small or isolated PAPs.
Key Points:
Question Due to the rarity of pulmonary pseudoaneurysms, mostly seen in severe chronic infectious pulmonary disease such as tuberculosis, percutaneous treatment has not yet been standardized. Findings Transcatheter embolization via the pulmonary artery itself and often via systemic artery, in particular bronchial-to-pulmonary-artery shunts, is an effective treatment of those pseudoaneurysms. Clinical relevance Life-threatening pulmonary hemorrhage can be treated using superselective embolization which requires an individual treatment plan based on the etiology of hemorrhage, the clinical status of the patient, and the vascularization of the pseudoaneurysms as shown by CT and angiography.
Insights
Pulmonary artery pseudoaneurysms (PAPs), often caused by tuberculosis, can be effectively treated with embolization. Pulmonary artery embolization (PAE) and systemic artery embolization are effective, with medical treatment viable for smaller PAPs.
Area of Science:
- Interventional Radiology
- Pulmonary Medicine
- Vascular Surgery
Background:
- Pulmonary artery pseudoaneurysms (PAPs) are rare vascular lesions.
- PAPs are frequently associated with infectious lung diseases like tuberculosis and necrotizing pneumonia.
- Treatment strategies for PAPs are not yet standardized due to their rarity.
Purpose of the Study:
- To evaluate therapeutic approaches for pulmonary artery pseudoaneurysms (PAPs).
- To assess the outcomes of various treatments for PAPs with different etiologies and types.
- To provide insights into effective management strategies for PAPs.
Main Methods:
- Retrospective analysis of 29 PAPs in 28 patients from March 2010 to March 2024.
- Evaluation of patient characteristics, underlying lung abnormalities, PAP characteristics, and therapeutic interventions.
- Assessment of treatment outcomes, including regression, cessation of hemoptysis, and mortality.
Main Results:
- The primary etiologies were pulmonary tuberculosis (76%), necrotizing pneumonia (21%), and iatrogenic (3%).
- Pulmonary artery embolization (PAE) and systemic artery embolization (SAE) were the main interventional treatments.
- Treatment resulted in regression or cessation of hemoptysis in 24 PAPs (83%), with no procedural complications.
Conclusions:
- PAE is an effective treatment for PAPs.
- Embolization via systemic-to-pulmonary artery shunt is a viable alternative for PAPs not detected on pulmonary angiography.
- Medical management is a consideration for small or isolated PAPs.
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