Therapeutic approaches for pulmonary artery pseudoaneurysms and analysis of outcomes

Abstract

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.

Keywords: Bronchial artery; Embolization; Hemoptysis; Pseudoaneurysm; Pulmonary artery.