Emergency endovascular management of pulmonary artery aneurysms and pseudoaneurysms for the treatment of massive haemoptysis.

Introduction: In this study we report the results of endovascular techniques for the management of pulmonary artery aneurysms (PAA) and pseudoaneurysms (PAPS).

Methods: Cases with massive haemoptysis due to PAA and/or PAPS that were managed by endovascular means were included in the study. Clinical history and procedure details were analysed. Primary endpoints were immediate technical success and re-intervention rate; secondary endpoints were survival rate and relapse of bleeding.

Results: Among the 72 patients with massive haemoptysis who were treated in our department during an 8-year period, 6 patients with 6 lesions (2 PAA, 4 PAPS) fulfilled the inclusion criteria and were included in the study. The mean age was 46.5 years; mean lesion diameter was 12.7 mm (range 4-22 mm); underlying pathologies were vasculitis (n=2), erosion by necrotic tumour (n=1), previous lung surgery (n=1) and infectious disease (n=2). Four lesions were treated with coils, 1 with coils and a bare stent, and 1 with a covered stent. The technical success was 100%. Mean follow-up was 20.4 months. The re-intervention rate was 50%, but in only 16.6% was it related to the treated lesions. Survival rate was 66.6%. There were no major or minor complications.

Conclusion: Endovascular management offers a safe and effective solution for the emergency treatment of massive haemoptysis due to PAA and PAPS. A variety of endovascular devices may be used, according to the size and the anatomical location of the lesion.