Pulmonary artery occlusion with ethylene vinyl alcohol copolymer in patients with hemoptysis: initial experience in 12 cases

Abstract

Objective: The purpose of this study was to evaluate the feasibility and efficacy of pulmonary artery occlusion with ethylene vinyl alcohol copolymer in patients with hemoptysis.

Materials and methods: We reviewed the cases of 12 consecutively registered patients (10 men, two women; age range, 21-83 years; mean, 54.5 years) who were treated for hemoptysis by pulmonary artery occlusion with ethylene vinyl alcohol copolymer. The indications, immediate hemoptysis control, and clinical tolerability were analyzed.

Results: The underlying diseases were necrotizing pneumonia in four patients, necrotizing aspergillosis in one patient, complex aspergilloma in two patients, active tuberculosis in two patients, lung cancer in two patients, and Behçet disease in one patient. Ethylene vinyl alcohol copolymer was used alone in nine patients and with steel coils in three patients. The main indications were a small-necked pulmonary artery pseudoaneurysm in five patients, necrotic process in four patients, presence of systemic reperfusion of a pulmonary artery pseudoaneurysm in one patient, absolute necessity for anticoagulation therapy in one patient, and need to complete pulmonary artery aneurysm sac occlusion in one patient. The injection procedure was well tolerated. Hemoptysis of pulmonary arterial origin was controlled in all but one patient, who had progression of the infectious disease and underwent surgery. In two patients, hemoptysis recurred from systemic arteries and was treated with embolization of the systemic arteries in one patient and surgery in the other patient.

Conclusion: Ethylene vinyl alcohol copolymer embolization for hemoptysis of pulmonary arterial origin is feasible and efficacious. Use of this embolization agent is beneficial in patients with pulmonary artery injuries, especially those with small-necked lesions.