Intra-Aneurysmal Glue Embolisation of a Giant Pulmonary Artery Pseudoaneurysm after Left Upper Lobe Lobectomy: Case Report

Abstract

We report a case of pseudoaneurysm of the anterior ascending branch of the left pulmonary artery, following a left upper lobectomy for pulmonary aspergillosis, for which we have done an endovascular treatment. This is the first case where complete pseudoaneurysm occlusion was accomplished after a transcatheter intra-aneurysmal N-butyl 2-cyanoacrylate (glue) injection.

Becoming the Standard: Expanding the Conventional Use of Interventional Embolization for Ruptured Pulmonary Artery Aneurysms

“…Complications such as perivascular leaks, anastomotic leaks, and graft thrombosis have also been reported [2]. Surgical lobectomies, in particular, cause an increased risk of developing recurrent PAAs or pseudoaneurysms, secondary to increased post-operative pulmonary pressures [9]. Specifically, surgical management has been challenging for patients with Behcet’s disease since their complete care often includes immunosuppressant medications, which can impede post-surgical healing.…”

“…Specifically, surgical management has been challenging for patients with Behcet’s disease since their complete care often includes immunosuppressant medications, which can impede post-surgical healing. Furthermore, due to the high-risk of PAA rupture, surgical repair is not recommended as the standard of treatment for large pseudoaneurysms [9]. While surgery has been noted to be the indicated management in emergencies, the increased risk of complications makes an interventional endovascular approach more appropriate in such cases [4].…”

Pulmonary artery mycotic aneurism owing to aspergillus in SARS-CoV-2 convalescent: a case report and literature review

“…26 Due to the potential risk of high mortality of up to 50% secondary to the growth of the pseudoaneurysm and its rupture, context in which immediate treatment is mandatory. 24,30,31 Some consider bronchial artery embolization simply as a bridging therapy until definitive treatment can be provided.…”

“…23 Due to the low incidence of this pathology, few bibliographies mention the indication of treatment, the recommendation is based on the hemoptoic volume, oxygenation and extension of the arterial damage, a suggested cut-off point is a volume <200 ml in 24-48 hours to consider the interventional radiology approach with embolization. 24,29,30 Successful intraluminal coiling requires an intact coagulation cascade and reduced blood pressure to promote thrombosis, making this option challenging because mycotic pseudoaneurysms commonly present with sepsis and coagulopathy. 25 The placement of stents or grafts in patients with active bacteremia or resistant microorganisms should be avoided due to the high possibilities of graft seeding.…”