Endovascular glue embolization for control of massive hemoptysis caused by peripheral pulmonary artery pseudoaneurysms: Report of 7 cases

Abstract

Purpose: Pulmonary artery pseudoaneurysms are a rare cause of massive hemoptysis and need to be considered as a differential with prompt recognition preventing mortality from life-threatening hemorrhage. We report the clinical details and imaging findings for a series of patients presenting with massive haemoptysis due to peripheral pulmonary artery pseudoaneurysm, managed by endovascular glue embolization. Methods: Hospital based retrospective study wherein records and image database of patients presenting with massive hemoptysis between January 2014 and March 2016 were studied. The immediate technical success, reintervention rate, and recurrence of massive hemoptysis were recorded. Results: Among patients with massive hemoptysis who underwent endovascular management in our department, seven patients fulfilled the inclusion criteria. The mean age was 54.3 years; mean lesion diameter was 10.8 mm (range 6–14 mm); underlying pathology being infective (tuberculosis) in all cases ( n = 7). All lesions were treated with endovascular glue embolization. The technical success was 100%. Mean follow-up was 11.7 months. There was no case of recurrence of massive hemoptysis. There were no major complications with a single case of minor complication (in the form of chest pain and discomfort) which resolved with medical management. Conclusion: The endovascular approach using glue (N-butyl cyanoacrylate) is a minimally invasive and technically feasible, effective technique for emergent management of pulmonary artery pseudoaneurysms presenting as massive hemoptysis.

Pulmonary Artery-Tracheal Fistula After Coil Implantation for Behcet’s Disease

“…Endovascular embolization has been described as an effective treatment for the complication of hemoptysis in patients with PAAs. Cyanoacrylate glue has been used to treat hemoptysis in patients with tuberculosis, with good medium-term results [ 9 ]. Other endovascular techniques such as coil implantation to promote thrombosis within the aneurysm have also been used with varying success.…”

Endovascular management of massive hemoptysis due to pulmonary artery pseudoaneurysm in a COVID-19 patient in Vietnam: A case report

“…Surgery has a high morbidity and mortality rate, especially in patients with pulmonary hypertension [8] . Endovascular intervention has the advantages of being minimally invasive, safe, and effective, and it can be performed under local anesthesia [9] . Ninety-five percent of hemoptysis originates from the bronchial arteries and 5% from the pulmonary artery.…”

“…Common embolic agents are coils, Amplatzer vascular plugs [11] , n-butyl cyanoacrylate glue [9] , and Gelfoam or polyvinyl alcohol. Coils can be used to superlectively embolize the pseudoaneurysms or parent vessels [ 5 , [9] , [10] , [11] ].…”

“…Common embolic agents are coils, Amplatzer vascular plugs [11] , n-butyl cyanoacrylate glue [9] , and Gelfoam or polyvinyl alcohol. Coils can be used to superlectively embolize the pseudoaneurysms or parent vessels [ 5 , [9] , [10] , [11] ]. The embolization technique depends on the pulmonary artery pseudoaneurysm's location, type, and anatomy and the experience of different interventional units [12] .…”